Basically, we treat sick patients as if they are broken machines that need to be fixed. ‘Real’ science doesn’t include concepts such as compassion or healing. The placebo effect, despite being a powerful healing response, is dismissed in our analysis of medical treatments. We objectify patients by focusing on the disease process, not the person with the illness. Indeed, we even identify patients by their pathology, referring to ‘the gall bladder on ward 6’ and ‘the breast abscess on ward 4.
Modern systems of healthcare resemble factory production lines more than places of healing. Managers view their organisations as machines, in parallel to doctor’s mechanistic views of patients. Their most important priorities are financial targets, efficiency and throughput. From the managers’ point of view, patient care consists of tasks, procedures and bed days. Care, compassion and healing don’t show up on a spreadsheet.
Even in non-profit organisations, the profit motive strongly shapes the nature of medicine because most of our interventions are those which earn money for pharmaceutical and technology companies. In a capitalist economy, the healthcare industry makes money out of sickness and has little interest in promoting health, healing or wellbeing. Even cancer is turned into a chronic disease that earns a fortune for pharmaceutical companies.
The heroic model of medical practice doesn’t allow doctors to have feelings. In our daily work we witness horrible disease, injury, pain, suffering and death; we try to survive this trauma by detaching ourselves from our feelings and pretending we are super-heroes who can fix and save every patient. This heroic role-model of being a doctor means that we, in turn, brutalise our students and trainees. In our relations with patients we too often adopt a clinically detached style of practice that doesn’t acknowledge the feelings of patients either.
These factors together lead to horrifying rates of burnout among health professionals – international surveys report that about 30% to 40% of all health professionals have symptoms of burnout including emotional exhaustion, depersonalisation and cynicism. There’s a fundamental disconnection between the ideals that motivate health professionals and the reality of the work environment.
The four drivers of healthcare so profoundly affect the culture of healthcare that there is little space, time or incentive for compassionate caring. In this setting, the evidence that compassionate care can improve patient outcomes, reduce costs, and give joy to health professionals simply doesn’t stack up. It makes no sense from a materialistic, business or clinical perspective. Having a great idea, backed up with strong evidence, doesn’t change anything at all if it contradicts the predominant world view.
And so our experience has been that no matter how fired up and enthusiastic health professionals are about bringing their hearts to work, this impulse is too often crushed by the daily realities of the work environment. A few courageous individuals manage to overcome the culture of the system but they are often labelled as mavericks and a threat to authority.
So at Hearts in Healthcare, after many years of effort we have come to the conclusion that it is futile to try to change the existing healthcare system. Healthcare is in deep crisis: rapidly escalating costs, appalling outcome measures, epidemics of obesity and diabetes, and widespread burnout of those dedicated to care. It’s a dying system and the best we can do within the old system is palliative care.