EyeWorld India June 2015 Issue

73 EWAP NEWS & OPINION June 2015 by Lauren Lipuma EyeWorld Staff Writer Treating the person and not the case Is the human element disappearing in modern medicine? T he modern medical era has introduced many changes to the practice of medicine, especially when it comes to the doctor/patient relationship. Some physicians think that modern practice conditions have weakened the connection between doctor and patient, fostering a mentality of treating patients as cases rather than individuals. As a result, both a patient’s experience and quality of care can suffer. “I think physicians want to think of patients as people to be cared for, but the rules in medicine are quickly changing,” said Sumitra Khandelwal, MD , assistant professor of ophthalmology, Baylor College of Medicine, Houston. “Reimbursement is declining, while overhead, due to increasing demands such as EMR and the purchase of new technology, creates a situation where a physician needs to see more patients in order to make ends meet.” “As we have more limited time to see people, and also as our field becomes more subspecialized, it becomes even easier in a sense to see people as [a] condition rather than who they are,” said Leana Wen, MD , director of patient- centered care, Department of Emergency Medicine, George Washington University, Washington, DC. A longtime advocate for individualized patient care, Dr. Wen thinks that the language and culture of medicine unintentionally contribute to the mentality of seeing patients as cases. Although students learn about the importance of humanism and empathy in medical school, she said, these lessons are not fostered in medical training and as a result, are lost. “I don’t think that any of us go into medicine, or nursing, or the health professions to treat people as diseases and not care about them as individuals,” Dr. Wen said. “This is not something that we want to do, but it is something that in medicine we learn through role modeling. “For example, in emergency medicine, instead of saying ‘Ann Taylor, the 57-year-old woman in that room,’ we might say, ‘the 57-year-old with chest pains,’ or ‘the chest pains in room 5,’” she said. Certain situations, such as grand rounds, also make it difficult to connect with patients, Dr. Khandelwal said. “We used to do live patient grand rounds where you could meet the patients, examine them, and discuss their condition and possible treatment as a group every week,” she said. With limited time, however, and the difficulty in getting patients to attend, her team now reviews cases on PowerPoint presentations most of the time. Pertaining to ophthalmology Ophthalmology is unique, Dr. Khandelwal said, in that it is a highly specialized field but also provides continuity of care. She thinks ophthalmologists see patients differently than other specialties because of the impact that vision has on a patient’s life. “For my dry eye patients, for example, I end up finding out more about their hobbies and what bothers them and what their goals are,” she said. “However, ophthalmologists do tend to focus on what is in front of them—the eye. It’s a small important organ and therefore easy to not take into account the rest of the patient’s story.” This mentality has the ability to impact not only a patient’s experience but the quality of care as well. “Your subjective perception of your care very much ties into the objective representation of it,” Dr. Wen said. “We know, based on numerous studies, that having trust is critical, that good communication fosters that trust, and increasing trust will increase patient compliance and will improve patient outcomes. So I don’t think it’s just about patients’ perception … but it very much ties into their overall outcome at the end of the day.” Connecting better In emergency medicine or procedural fields, it is difficult to humanize a patient, Dr. Wen said, because the patient is there for one reason, and with limited time, the physician wants to address that reason quickly. Yet even in a hectic environment such as an emergency room or in a specialty where the diagnosing physician never meets the patient, things can be done. In 2008, a group of radiologists presented data at the annual meeting of the Radiological Society of North America (RSNA) showing that when a patient’s photo was included with imaging exam results, the treating radiologist examined the images more meticulously and took a more personal and empathetic approach. “The photos were very helpful in terms of improving diagnosis and the physicians’ feelings as caregivers,” said Yehonatan Turner, MD, Shaare Zedek Medical Center, Jerusalem, Israel, the study’s lead author, in a press release from RSNA. “Our study emphasizes approaching the patient as a human being and not as an anonymous case study.” “One way of thinking of people as individuals is to ask them something personal,” Dr. Wen said. “We know that stories are what humanizes us and what connects us, so identify every patient with a particular story. “I would also encourage doctors continued on page 74