The Business of Care

There's frustration and dissatisfaction throughout the continuum of the healthcare encounter. Bright and caring physicians, nurses, and other health professionals are disillusioned that healthcare has become less about health and care, and more about disease and management. Healthcare. Disease management. Which inspires you? For many, "managed care" isn't well managed, and isn't caring.

So what's the payoff for people who came to their work with a mission of caring, now finding it dominated by paperwork, technology, time constraints, and an inability to care?

For those whose passion is in biomedical science, being a body mechanic - fixing broken parts - may be enough. But for those who agree with Sir William Osler that "It is more important to know what sort of person has a disease than to know what sort of disease a person has", it's not.

The chief of medicine for one of the Armed Forces once told me that "Most of the people who come to see me are just lonely." And, as we now know that one's mental and emotional state can greatly influence one's state of health and dis-ease, "For patients, the relationship with their provider frequently is the most therapeutic aspect of the health care encounter." (Health Professions Education and Relationship-Centered Care, p.9).

In our increasingly digital world, the "analog" subjectivity of relationship holds less weight. In order to reinvigorate and re-humanize healthcare, we need to demonstrate the cost benefit of relationship: of taking more time with patients, of both parties feeling heard and understood, feeling care and cared for.

We can begin to make a solid case for the economic benefit of "relationship-centered care." In The Sociophysiology of Caring in the Doctor-patient Relationship, Herbert M. Adler, MD, PhD, writes that “A caring relationship creates a setting of patient comfort that is most likely to result in a more complete medical history (82), improved clinical judgment with regard to laboratory tests and procedures, more accurate diagnoses, more cost-effective prescribing (95) (96), a more satisfied patient who is more informed and adherent to the treatment plan (97), (98), and better treatment outcomes (99)…”(Adler, 2002, p. 883)

The word "Heal" comes from the Old English "hale," which means: "to make sound or whole"; "to restore to health". And, as the wise physician Rachel Naomi Remen has written, “The greatest gift we bring to anyone who is suffering is our wholeness.”

To your health. To your wholeness.