Systemic Challenges for Care in Healthcare

Is healthcare indeed a place where a person can expect to receive genuine care? Or is the care in healthcare more of an abstract concept than something a patient might experience?

A recent paper in Health Expectations tells us that most patients define a caring professional quite simply. They listen attentively. That was the response of more than 70 percent of the time when Sofie Bagulie, Alina Pavlova, and Nathan Consedine asked 767 patients about the physician behaviors that led them to feel cared for. Other factors, like follow-up care and respecting preferences, were afterthoughts by comparison.

Stark Reality of Health Systems

But here’s the thing. Payers play on outsized role in health systems and thus, attentive listening fades into the background of other demands from the work of most healthcare providers. Writing in the Washington Post, Shirlene Obuobi describes the stark reality of this disconnect:

“I wish I could tell all of these patients that I do care; that I, like so many physicians before and after me, entered the medical field out of a desire to help others.

“But many patients define caring as taking the time to listen and thoroughly investigate their complaints, following up promptly on test results and advocating for them.

“This kind of caring takes time and resources that many practicing physicians are not given.

“There’s a clear disconnect between what most patients value in health care and what hospital systems and insurance companies want. The American medical system rewards procedures, imaging, tests and other diagnostics that generate revenue and have high reimbursement rates.“

The problem lies with the systems we’ve built that devalue caring in healthcare.

Overthrowing Barriers to Empathy

Jeremy Howick and Sian Rees are quite blunt about it. Writing in the Journal of the Royal Society of Medicine, they say people need to overthrow systemic barriers that “value targets over people” and do not give “the opportunity to express their inherent empathy.”

Concern about greed seemingly lost a bit of resonance in popular culture a few decades ago. A hard look at how healthcare systems are working, though, might encourage us to bring it back. Healthcare without caring delivers little in terms of good health.

Click here for Obuobi’s perspective in the Post, here for the research in Health Expectations, and here for the paper by Howick and Rees.

Young Mother Contemplating Her Sleeping Child, painting by Albrecht Anker / WikiArt

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November 19, 2022