IN today’s healthcare industry, the distinction between objects and human beings has become increasingly blurred. The tendency to see the patient as an object rather than a living person is almost universal. As with other modern-day businesses, the medical profession too is incorporating market-based, scientific or bureaucratic terminology. Money has become the central motive in every aspect of the contemporary healthcare system.
Our unconsciously biased belief system regarding the nomenclature of those who are sick and those taking care of the sick (clinicians) has created a multi-dimensional framework comprising four important domains.
The first domain is purely scientific, termed as an ‘object-observer relationship’. It depicts clinicians as objective scientists and the sick as material bodies for experimentation by way of examination, investigation, diagnoses and cure. This model expects patients to see themselves as objects to be studied or treated.
It is an approach that distances the patients from their living experience and depersonalises them, turning them into objects for testing a hypothesis. The problem with this model is that it ignores the healing aspects of the science of medicine and projects it as a mechanism of cause, effect and intervention.
Physicians must humbly ‘incline’ towards their patients.
The second domain is of the economic type, termed the ‘buyer-seller relationship’. In this model, the physician’s role is that of a provider and the patient’s of a customer. While the patient is considered a buyer of health and healing apparatus, the clinician is a seller of expert knowledge and techniques.
Though economic considerations are crucial for the success of medicine, this model should not be a basis for the patient-clinician relationship because illness and healing are elements of the human experience that should not be for sale. The patient-clinician relationship must remain a bond based on dependence and mutual trust, with finances always the secondary factor. For healing to flourish, the patient-clinician relationship needs to be shielded from economic tenability as a primary motivation.
The third force driving the doctor-patient relationship is bureaucratic, referred to as a ‘user-manager relationship’ where clinicians are health managers and administrators in institutionalised healthcare and patients are end users. Physicians have designated technological requirements, eg spending more time in front of computer screens and filling out paperwork than in looking, talking, touching or analysing the patient. Patients are regarded as itemised boxes to be checked and completed. While the organisational dimension of care is essential considering the socioeconomic complexities of modern medicine, it also threatens the humane connection in the healing encounter.
In contrast to the impersonal forces, there is a fourth dimension largely framed by the practice of hospitality. In the context of illness, hospitality is an individual and collective practice in which the unwell stranger is graciously received by all components of the healthcare delivery system. It is regarded as a ‘guest-host relationship’. Among the taxonomy of patient-clinician models, hospitality stands out because it combines characteristics that are authoritarian, patient-centred and mutually interactive. From the enriched perspective of hospitality, patients are considered predominantly as subjects and not objects. The clinical encounter establishes a personal rather than impersonal relationship.
The word ‘clinician’ is derived from the Greek word ‘Kline’, meaning bed, denoting the one who attends at the bedside. The verb associated with clinician is ‘klino’ translated as to ‘incline’, ‘bend’ or ‘bow’. Serious illness is distressing, yet the hospitality aspect of a ‘guest-host relationship’ creates a sacred space of human love with mysterious healing powers.
Human suffering is not something that can be entirely fixed with money or more rigorous bureaucratic measures. The foundations of healing need to be applied to modern medicine so as to engage both the physical and spiritual needs of the patient. If physicians collectively understood their identity as those who humbly ‘incline’ towards their patients, healthcare would have been transformed.
The transition to hospitality is a re-emerging phenomenon in modern medicine. Hospitals and medical professionals need to be more receptive to the need for inculcating a humane, friendly and hospitable culture in healthcare.
A spiritual relationship is more important than all the money or technology we might spend on illness. While the medical profession is looking towards wider disciplines that help cure the seemingly incurable, it is worth exploring these perennial concepts that invite us to look deeper into the interaction of curing, caring and healing.
The writer is a Harvard graduate.
Published in Dawn, November 14th, 2019