A Patient, Not a Person
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Healthcare Leadership Jun 4, 2012

A Patient, Not a Person

Medicine’s bad habit of dehu­man­iz­ing patients

Female doctor, nurse and patient in hospital

GenerationClash via iStock

Based on the research of

Omar Sultan Haque

Adam Waytz

Listening: Interview with Adam Waytz on Dehumanization

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In med­i­cine, patients are often treat­ed as slight­ly less than human — some­times unin­ten­tion­al­ly, and some­times to help doc­tors do their jobs. Mak­ing patients into peo­ple again while still giv­ing them the best treat­ment is not a sim­ple task.

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As though being in the hos­pi­tal were not bad enough — there is the hos­pi­tal gown, gap­ing open in all the wrong places; the effi­cient but unpleas­ant tests; the doc­tor too absorbed in your chart to make eye con­tact — the imper­son­al rou­tines and small humil­i­a­tions of med­i­cine can leave patients feel­ing demor­al­ized. But more than that, these prac­tices unin­ten­tion­al­ly dehu­man­ize patients, treat­ing them as not ful­ly capa­ble of think­ing, mak­ing deci­sions, or — as many a patient will winc­ing­ly agree after a par­tic­u­lar­ly brusque exam — feeling.

Adam Waytz, an assis­tant pro­fes­sor of man­age­ment and orga­ni­za­tions at the Kel­logg School of Man­age­ment, and Omar Sul­tan Haque, a psy­chol­o­gist and physi­cian at Har­vard Uni­ver­si­ty, cat­a­logued six prac­tices that lead to dehu­man­iza­tion in hos­pi­tals and sug­gest­ed pos­si­ble alter­na­tives that would dimin­ish it with­out com­pro­mis­ing care.

Cat­a­loging the Caus­es

The caus­es of dehu­man­iza­tion in med­i­cine, Waytz and Haque found, fell into two cat­e­gories. Some were sim­ply byprod­ucts of the clin­i­cal sys­tem. One such cause is dein­di­vid­u­a­tion, the prac­tices that take away iden­ti­fy­ing char­ac­ter­is­tics and make both doc­tors and patients seem less like indi­vid­u­als and more like part of larg­er groups: legions of doc­tors all don­ning white coats, gown-wear­ing patients in rows of iden­ti­cal beds. The patients all begin to blend togeth­er, to seem less like indi­vid­u­als with dis­tinct con­cerns. And as for the doc­tors, Waytz says, this sea of white coats los­es their indi­vid­u­al­i­ty,” mak­ing them feel less per­son­al­ly respon­si­ble for their patients and their actions.

When diag­nos­ing a patient, physi­cians often think of the patient not as a per­son, but as some­thing made up of inter­act­ing sys­tems, a prac­tice called mechanization.

Patients are dehu­man­ized, too, by what is known as impaired agency, a less­ened abil­i­ty to think or plan for one­self. Many patients’ con­di­tions — whether they are in a coma or sim­ply grog­gy-head­ed from med­ica­tion — keep them from mak­ing all the nec­es­sary decisions.

The dis­sim­i­lar­i­ties between doc­tors and patients con­tribute to dehu­man­iza­tion, as well. Peo­ple tend to think of peo­ple less like them­selves as being less human, social psy­chol­o­gists have shown. Doc­tors are healthy and oper­at­ing in a sit­u­a­tion in which they are com­fort­able and com­pe­tent. Patients are, of course, sick or injured — and what’s more, any­one who’s going to the hos­pi­tal or the doctor’s office is there pre­cise­ly because they lack the abil­i­ty to make them­selves bet­ter or self-diag­nose,” Waytz says. The dynam­ic of a healthy per­son in pow­er and an ill one need­ing help sets up a dehu­man­iz­ing relationship.

Unin­tend­ed Consequences Dein­di­vid­u­a­tion, impaired agency, and dis­sim­i­lar­i­ty do not serve a par­tic­u­lar pur­pose; they are side effects of the way the med­ical sys­tem is set up. Oth­er caus­es of dehu­man­iza­tion, how­ev­er, can actu­al­ly help health­care work­ers han­dle a tough job. Despite dehu­man­iza­tion hav­ing neg­a­tive effects on patients’ reports of the qual­i­ty of care that they receive, it has some ben­e­fits for nurs­es and doc­tors,” Waytz says. Ear­li­er stud­ies found that dehu­man­iz­ing patients can reduce health­care work­ers’ feel­ings of burnout, and let them cope bet­ter with the con­stant pain and ill­ness they see.

When diag­nos­ing a patient, physi­cians often think of the patient not as a per­son, but as some­thing made up of inter­act­ing sys­tems, a prac­tice called mech­a­niza­tion. Think­ing of a patient as the sum of their parts — car­dio­vas­cu­lar sys­tem, bio­mark­er lev­els, tumor cells — can help doc­tors pin­point what is wrong and deter­mine how to fix it. But it also means think­ing of patients as mechan­i­cal objects, made up of inter­act­ing sys­tems, rather than as people.

Doc­tors also show less empa­thy to patients’ pain than non-doc­tors do, sug­gest­ing they are not think­ing of patients as hav­ing ful­ly human feel­ings. A recent neu­roimag­ing study found that, when watch­ing a patient get pricked with a nee­dle, physi­cians showed far less acti­va­tion in brain areas linked to empa­thy. This less­en­ing of empa­thy, Waytz and Haque say, like­ly comes from med­ical train­ing. Since feel­ing the pain of each patient would be over­whelm­ing, future physi­cians are encour­aged to con­trol and mit­i­gate their respons­es to oth­er people’s pain, free­ing up valu­able men­tal resources for diag­nos­ing and treat­ing patients but again treat­ing them as some­what less than human.

Physi­cians pledge to do no harm, but many med­ical pro­ce­dures — surg­eries and set­ting bones, for exam­ple — are painful. This leads to moral dis­en­gage­ment in which doc­tors dis­tance them­selves from patients so that will­ful­ly inflict­ing pain on anoth­er per­son — some­thing that would be abhor­rent in oth­er cir­cum­stances — becomes permissible.

Find­ing a Fix Once they had iden­ti­fied the caus­es of dehu­man­iza­tion, Waytz and Haque pro­posed poten­tial fix­es that could lessen it. Since they hope that these fix­es could be tried and test­ed in clin­i­cal set­tings, Waytz says, these are not things that would cost any mon­ey. They’re just prac­tices, and real­ly minor practices.”

For the caus­es of dehu­man­iza­tion that do not serve a pur­pose, Waytz and Haque pro­pose small tweaks that would keep both doc­tors and patients from falling into that mind­set. Chang­ing prac­tices that usu­al­ly make patients and doc­tors anony­mous mem­bers of larg­er groups — hav­ing doc­tors not wear iden­ti­cal coats, for instance — can human­ize both groups by mak­ing their indi­vid­u­al­i­ty appar­ent. Let­ting patients make more deci­sions or giv­ing them respon­si­bil­i­ty can increase their agency; an ear­li­er study found that car­ing for a plant or tak­ing on sim­i­lar tasks helped patients at a nurs­ing home live longer. Focus­ing on patients’ human­i­ty rather than label­ing them as their dis­ease — call­ing a patient Mr. Smith, who has dia­betes” rather than the dia­bet­ic in room 341” — can remind doc­tors how much they and their patients have in common.

Sev­er­al oth­er prac­tices could help human­ize patients with­out less­en­ing health­care work­ers’ abil­i­ty to do their jobs, Waytz and Haque sug­gest. Say­ing a sen­tence or two about a patient’s back­ground, job, or fam­i­ly life — infor­ma­tion often already avail­able on their chart — at the begin­ning of hos­pi­tal rounds, for instance, could remind doc­tors of the patient’s human­i­ty. To increase empa­thy with­out mak­ing it dif­fi­cult for doc­tors to oper­ate or per­form painful pro­ce­dures, med­ical train­ing could help them learn when empa­thy is nec­es­sary and when detach­ment is. A sur­geon could empathize with a patient dur­ing an office vis­it, then reg­u­late his emo­tions and become more detached in the oper­at­ing room.

Waytz hopes to soon test these prac­tices in a clin­i­cal set­ting. We pro­posed these inter­ven­tions based on the psych lit­er­a­ture and based on Omar [Haque]’s expe­ri­ences as a physi­cian, but future research has to deter­mine whether our sug­ges­tions are real­ly effec­tive,” he says. Under the unique demands and sit­u­a­tions of hos­pi­tal life, some inter­ven­tions might prove infea­si­ble, while oth­ers could have a big effect for lit­tle effort. To do those tests, Waytz says, we have an open call for any­one in the med­ical world who would like to col­lab­o­rate with us.”

Relat­ed read­ing on Kel­logg Insight

Mak­ing Up Our Minds: When are peo­ple indi­vid­u­als and when are they part of a group?

Con­gen­i­tal Defect: Sys­temic hos­pi­tal cost inflation

Featured Faculty

Adam Waytz

Assistant Professor of Management & Organizations

About the Writer

Valerie Ross is a science and technology writer based in New York, New York.

About the Research

Haque, O. S. and Adam Waytz. 2012. “Dehumanization in Medicine: Causes, Solutions, and Functions.” Perspectives on Psychological Science, 7(2): 176-186.

Read the original

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