Medical Technology Is Making Humanism a Lost Art
New health care regulations may help bring humanity back to medicine.
A lot has been written lately about the loss of humanism in medicine. In medicine, “humanism” means seeking to understand the patient as a whole person (including the patient’s individual values, goals, and preferences), rather than as a set of symptoms or data points. The lost art of palpation—truly “hands on” medicine—and the importance of making a physical, mental, and emotional connection with the patient, has been discussed by physicians such as Abraham Verghese, MD (“Culture Shock – Patient as Icon, Icon as Patient,” New England Journal of Medicine; Dec. 25, 2008) and Teresa A. Gilewski, MD, in development of the “Art of Medicine” lecture series at Memorial Sloan-Kettering Cancer Center, and in her film “The Physician as the Patient.”
The “human element” in medicine is fundamental. The caregiver who foregoes palpation, auscultation, and personal observation may miss not only a diagnosis, but also the opportunity to connect with the patient in a way that meaningfully improves care. Genuine interest in, and attention to, whether a patient is taking his medication and how he is responding to treatment are important, as are listening to a patient’s concerns and understanding the entire scope of his or her emotional, social, and medical issues. Patients are more inclined to be compliant and follow the care plan provided to them when they feel as though they can communicate freely with their providers, that the entire staff is interested in them as a person, and that they are part of the decision-making process.
Medical Humanist Helps Improve Health Outcomes
In 2002, the Institute of Medical Humanism introduced a “medical humanist” at a regional cancer center in Vermont. The medical humanist’s role was to interpret physician language, communicate that to the patient, and then write the patient’s experience into the medical record. Evaluating the results of this pilot program, the institute concluded, “Incorporating a medical humanist on an inter-disciplinary team served to bridge the differences in language, facilitated doctor-patient communication, fostered collaborative health care decision-making and helped to improve health outcomes.”
Technology Creates Distance
The program’s success also reveals a sad reality: Patients and physicians are no longer communicating one-on-one. Although medical science has made amazing strides in recent decades, an increasing reliance on technology seems to have created a greater distance—psychologically as well as physically—between patients and physicians.
New Programs Seek to Bridge the Communication Gap
Concern about the “patient experience” may seem out of place in evidence-based practice, but health care regulations now in development include requirements for patient satisfaction.
On the hospital side, Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey questions ask for patient feedback regarding nurses, doctors, hospital staff, and with their own pain control. These measures will be continued in 2012 and include reimbursement provisions, according to the 2012 Medicare Outpatient Prospective Payment System final rule. As noted in a HealthLeaders Media Intelligence Unit report, “Patient Experience: Help Wanted,” leaders are struggling to attain top scores and meet these and other incentives for improving patient satisfaction.
As another example, the Medicare Shared Savings Program will reward accountable care organizations (ACOs) that lower health care costs while meeting performance standards on quality of care and putting patients first. ACOs that do not meet these standards will not be eligible to share any savings realized under the ACO model.
The 2012 Medicare Physician Fee Schedule final rule likewise discusses a new value-based payment modifier to be phased in beginning in 2015. Some of the quality measures involve patient safety, as well as the patient experience and functional status.
Getting caregivers more involved with their patients is quickly becoming a fiscal priority. Physicians may have to adjust schedules to spend more time with patients, and will have to take greater advantage of new care models. For example, other providers in their medical home or office structure may be able to get telephonic results for congestive heart failure (CHF); patient weights; provide patients with an easily understood home program to follow; follow up with the patient at home; and call patients regularly to determine whether they need additional assistance, changes in their prescriptions, or an appointment to see the physician. This allows for expedient and safe treatment for the patients who are not personally seen as often, and for more time available when they do come into the office.
The new practice models are old models revived in a new environment of higher health costs and new technology. We can incorporate humanism and compassion into our medical practice to increase revenue, patient compliance, and satisfaction.