Author: Michael Wasserman MD
Originally Published : Tuesday, March 22, 2016
Over the past few years, I have enjoyed teaching first- and second-year medical students about the art of interviewing patients. While it’s certainly good to give back, it has also been an eye-opening experience. Recently, as I sat and watched a medical student try to tell the “patient/actor” that they had a terminal illness, one thing was clear: The student was focused on the diagnosis and the disease itself. I kept thinking to myself, while watching the student try to find ways of delivering the bad news, that they needed to find out who the person was. They needed to understand the patient as a human being! I actually paused the interview a couple of times and encouraged the student to focus on the person. They couldn’t bring themselves to break away from the focus on the diagnosis. I realized afterward that this is the norm in health care.
Many of my colleagues are focused on diagnosis, treatment, and cure. They are also focused on getting paid. There appears to be a limited amount of time in the doctor-patient interaction. There is a strong feeling that there isn’t time for things that are “less” important. However, as is often the case in life, we can be pennywise and pound foolish. I’ll never forget an older patient of mine who had injured his finger. While it seemed to be a small thing, it mattered very much to him, as one of his favorite things in life was playing the violin. That’s just the tip of the iceberg.
In a recent, mind-blowing book, Listening for What Matters: Avoiding Contextual Errors in Health Care, Drs. Saul Weiner and Alan Schwartz point out how inept most physicians are at understanding the context within which their patients live. Why is this important? Because if we truly want to practice person-centered care, we must know who the person is! This is such an obvious and profound concept, it is remarkable how little attention it gets when approaching the education of young physicians.
We make sure that we teach anatomy and physiology. The latest information on neurosciences is drilled into the brains of medical students. Ultimately, when they arrive at their clinical years, reams of the latest information are expected to be learned. Ironically, a fair portion of what we “know” becomes obsolete within 10–20 years. What we teach students with regard to compassion and communication will never be obsolete, yet in this regard, we fail miserably.
Clinicians who practice geriatrics and palliative care understand the importance of function and quality of life in the care of their patients. In order to truly provide person-centered care, we need to get to know our patients on a more personal level. How do we know what someone wants if we don’t know who they are? We can’t afford to spend our time figuring out the diagnosis before figuring out who the person is, as this ultimately puts us at risk of not actually “caring” for our patient. In terms of the time it takes to practice this type of care, if you take the time up front, you will often save time down the line.
We hear a lot of talk today about how the field of population health will solve many of our health care problems. While I understand the value of approaching problems from a broader population-based model, I struggle with what will happen to the concept of person-centered care in a population health-based world. Will we fall further away from our already lackluster ability to know our patients as human beings? Will we ever truly be able to care for the individual? The shame of this is that we are presently doing a horrible job of educating and training young clinicians in this important area. Perhaps it’s time to take a step back and focus on what should really be important to all of us. That’s knowing who the person we are caring for truly is.