By: Mariah LaRue
The other day I ran across an article as I was scrolling through my twitter feed. It detailed an interview with a doctor who feels the trend toward quality measures in healthcare has taken the art out of medicine. Given what we have learned so far in our studies, this article got me thinking. In first quarter, we learned all about how low quality is a major problem plaguing our healthcare system. In second quarter, we talked about the importance of delivering personalized care that address a patients physiological and and psycho-social needs. Yet, in an attempt to improve quality, there has been a movement towards quality measures, protocols, and checklists to help clinicians ensure all proper steps are taken and a patient does not suffer undue harm. All of these efforts, though done with good intent, can make medicine feel a little impersonal, or mechanistic. At least that is what the doctor in this article was describing.
The fact that this doctor is disheartened with quality metrics and protocols is understandable. Patients are people, and deserve to be treated as such. No two patients are the same. They each have different needs, barriers, identities, and beliefs. Perhaps working under standardized protocols does make the patient feel dehumanized, or like their personal needs are not being addressed because the provider has to follow the protocol. It is reasonable that clinicians may feel stifled in their ability to practice medicine, especially if they feel the protocol is hindering their care delivery. On the other hand, healthcare quality is still shockingly problematic. Though we have been striving to close gaps in quality since to Err is Human and Crossing the Quality Chasm were released at the turn of the millennium, we still face alarming quality issues. In fact, just the other week a study from Johns Hopkins University was released suggesting medical errors are the third leading cause of death in the United States, right behind heart disease and cancer. It really is no surprise then that there is such a push to figure out just how to measure quality.
So what can be done? If quality metrics are here to stay, does that mean all patients are doomed to be treated as mechanistic bodies, and doctors as technicians following tedious protocols to diagnose a physiological problem? There is hope. As we learned in Dr. Lambert’s class, this mechanistic view of medicine is only concerned with the biological dimension of illness. This biological view, though important, overlooks the psychological and sociological dimensions of illness. The doctor in this article acknowledges the importance of incorporating the psycho-social dimensions of illness into medical treatment. The key is finding a way to address all three dimensions of illness while also providing quality. One way to to this is through communication.
Doctors may have to follow protocols, but with training, doctors can still use communication to build relationships and understand the unique challenges their patients face. Incorporating communication can add the art back into medicine. Ideally, this will lead to better quality care and patient experiences while allowing doctors to practice the art of medicine.
Photo from Seattle Municipal Archives under the free attribution license. Seattle Municipal Archives does not support this written work.