[As written/circulated 2008-09 for the Barnes-Jewish Hospital Ethics Committee members]
Most days entail a series of encounters – turning a hallway corner, crossing a lane of traffic, reaching for an object, finding a place in line, looking up from a table, chasing a prize, competing for a position, . . . Encounters reveal the set of values and the sense of purpose out of which we each decide how to proceed. To treat someone humanely is to be artistic, subjective, freeing, reciprocal, gentle, engaged, holistic, attentive, patient, modest, trusting, graceful, reconciling. In short, to be treated humanely is to be respected. To treat someone inhumanely is to be rough, indifferent, curt, suspicious, selfish, alienating, exploiting.
Excellent medical care is scientific, being grounded in research results. Statistical associations and concentration on damage/diseased body parts objectify the patient. Differential diagnoses reflect plausible cause and effect explanations. The patient’s immediate problem receives more attention than the patient’s larger story. Caregivers must be sufficiently detached to maintain aequanimitas or balance. Only by keeping the ‘aim eye’ fixed on patients as individuals worthy of respect, compassion, and fairness can caregivers avoid the indifference that degrades patient encounters into self-serving alienation . . . the indifference that leaves patients bruised, manipulated, exploited.
Do educational and medical practice settings promote humane encounters? Listen closely to discourse during rounds, call-room conversations, doctors’ lounge conversations, grand rounds, morbidity-mortality conferences, evaluation sessions, faculty meetings, medical staff meetings, discussions about ranking residency candidates, depositions, productivity reviews, . . . .
Professionalism and ethics firmly rooted in a humane approach to patient encounters necessitate a fourth language integrated with the scientific/clinical, the legal/regulatory, and the business languages upon which patient care is based. This fourth language is the language of respect, compassion, and fairness. Fluency with the language of respect, compassion, and fairness is not required to complete medical education, to pass post-graduate boards, to be rewarded by practice management, to secure hospital privileges, to pass recertification examinations, to be promoted, to be elected to national positions of leadership, . . . . Fluency with the language of respect, compassion, and fairness is, however, essential for sustaining the experience of being a humane caregiver who cares deeply about patients – especially the most difficult patients – and who brings a resolute social conscience to the practice of medicine.
Most days entail a series of encounters – turning a hallway corner, crossing a lane of traffic, reaching for an object, finding a place in line, looking up from a table, chasing a prize, competing for a position, . . . Encounters reveal the set of values and the sense of purpose out of which we each decide how to proceed. To treat someone humanely is to be artistic, subjective, freeing, reciprocal, gentle, engaged, holistic, attentive, patient, modest, trusting, graceful, reconciling. In short, to be treated humanely is to be respected. To treat someone inhumanely is to be rough, indifferent, curt, suspicious, selfish, alienating, exploiting.
Excellent medical care is scientific, being grounded in research results. Statistical associations and concentration on damage/diseased body parts objectify the patient. Differential diagnoses reflect plausible cause and effect explanations. The patient’s immediate problem receives more attention than the patient’s larger story. Caregivers must be sufficiently detached to maintain aequanimitas or balance. Only by keeping the ‘aim eye’ fixed on patients as individuals worthy of respect, compassion, and fairness can caregivers avoid the indifference that degrades patient encounters into self-serving alienation . . . the indifference that leaves patients bruised, manipulated, exploited.
Do educational and medical practice settings promote humane encounters? Listen closely to discourse during rounds, call-room conversations, doctors’ lounge conversations, grand rounds, morbidity-mortality conferences, evaluation sessions, faculty meetings, medical staff meetings, discussions about ranking residency candidates, depositions, productivity reviews, . . . .
Professionalism and ethics firmly rooted in a humane approach to patient encounters necessitate a fourth language integrated with the scientific/clinical, the legal/regulatory, and the business languages upon which patient care is based. This fourth language is the language of respect, compassion, and fairness. Fluency with the language of respect, compassion, and fairness is not required to complete medical education, to pass post-graduate boards, to be rewarded by practice management, to secure hospital privileges, to pass recertification examinations, to be promoted, to be elected to national positions of leadership, . . . . Fluency with the language of respect, compassion, and fairness is, however, essential for sustaining the experience of being a humane caregiver who cares deeply about patients – especially the most difficult patients – and who brings a resolute social conscience to the practice of medicine.