In 1948, the World Health Organization defined Health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.
In the past, we were born, lived, got sick and died at home. There were more infectious diseases to be concerned with, too, like polio, chickenpox, syphilis, and diphtheria. Patients were taken care of at home, and the contact with the doctor was more personal. There was more direct touch and contact with the patient, more symptom control and more support from the patient’s own family. The “family doctor” was the rule, and there were chances that your doctor had treated your parents, yourself and next would be treating your sons. This “family doctor” was familiar with the history and customs of your town and also knew your relatives and their histories. The doctor was not only your doctor, but also your counselor and friend.
With advances in Medicine came “specialization” where you would visit one doctor for your skin, one for your heart, one for your ankle, and even one for your mind. The same thing happened in medical schools. A doctor making rounds would not visit Mr Smith, but “Bed 15”, or “the Malaria Case”. Hospitals became businesses, and they were obligated to be more “efficient”. A doctor would have to see more patients, and wouldn’t have time to spend with the patient or relatives. If a patient asked the nurse something about his treatment, they often were told, “that’s the doctor´s business, and you just need to take you medicine.” This created depersonalized medical care.
In the XVI century, St Camillus of Lellis revolutionized hospital care in Europe. Hospitals at that time were more like prisons. The patients were placed there to protect other people from contagious diseases. St Camillus initiated the bathing of patients, feeding them, comforting them, and then attending to their other necessities. This was the first “humanization” of medical care.
Today, hospital and medical personnel need to remember that the patient is the center of the health system. Hospitals need to be more patient-oriented. This means that from the hospital’s first encounter with the patient, there should be an affectionate clerk to meet the patient with a smile and alleviate the initial fear of the patient. Like a hotel, the patient should be greeted in the ward by a person who explains the admission process, the hospital rules, how to call the nurse, when relatives can talk to the treating physician, visiting hours, etc. Dietician services should have a menu, similar to that of a restaurant.
And following the doctor’s recommendation, the patient could have his own choice of food. There should be a person at patient discharge time that ensures that the patient has received all the instructions, that he understands which medicines he must continue taking, and knows when he needs to follow up with his physician. The medical personnel should have more contact with the patient. Even ”being there”, in terminal cases, touching the patient hands when possible, can make a difference.
Remembering Maslov’s pyramid of necessities, a patient admitted to the hospital has physical, mental and spiritual needs. A “patient centered” approach treats the patient as a whole person, first, alleviating his physical complaints: pain, shortness of breath, nutrition; second, alleviating his worries: fear, depression, anger, and if possible, third, alleviating his spiritual suffering: anger against himself because he may think his illness is due to sin, or anger against a superior entity that let him suffer, etc.
At the entrance of one of the oldest hospitals in Rome, there is a quote that reads, “Come to be healed, if not healed, at least cured, and if not cured, at least comforted?” This is the philosophy that should prevail in our hospitals. But in order for this to happen, there needs to be an environment of competency and transparency, where each staff member is competent in his function. There also needs to be recognition for good work, in terms of patient satisfaction and excellent performance of tasks. This environment should recognize and value the work of each staff member: janitor, clerk, and doctor alike. A good doctor is not the one who performs the most tests or diagnostic studies, but the one who provides the correct diagnosis using evidence-based medicine, and gives the patient the treatment that best satisfies his wishes and specific condition.
But in order to do this, we need, also, to know ourselves. The staff member who knows his strengths and weaknesses will be more apt to help others, and give a more “humanized medicine”.
Dr Ulloa is a internist and an advisor to the Ministry of Health.
