Creating a Culture of Care Focused on Health, Not Illness

The goal of medicine is function and health. Clinicians who marry technical skills with humanities can see their patients and themselves in the larger context of family, society, history, politics, and economics. As a result, barriers to medication compliance and treatment are better understood, and improvements in health outcomes are more likely.

Providers can meet patients’ needs for dignity, health, and comprehensive clinical care while concurrently fulfilling obligations to capture patient data in the electronic age of payment reform and meet the demand for provider productivity through an understanding and appreciation of the humanities. Providers who understand and apply humanities—the study of the intersection of art, history, the individual experience, science, anthropology, and language—relate better to their patients and create environs for health. This was the overarching message of the session “Culture, Health and Healing: Humanities in Inter-Professional Collaboration and Patient Centered Care” presented by Paulette Hahn, MD, at the American College of Rheumatology’s 2016 Annual Meeting.

Providers who seek to enable patient health, rather than limit their practice to the treatment of disease, broadly accept that to treat the patient, the provider must see the ailment as preventing the fullness of socio-emotional and physical engagement with society. Clinicians, Hahn pressed, must be the first to extend a hand to help a patient to bridge illness to health.

Hahn explained how Maslow’s Hierarchy of Needs is relevant to the study and practice of medicine. The intersection of these needs—physiology, safety, love, esteem, and self-actualization—is the human condition, the humanities. An understanding of humanities helps providers better identify with their patients, improves clinical care and generates positive health outcomes.

The goal of medicine is function and health. Clinicians who combine their technical skills with the ability to see their patients and themselves in the larger context of family, society, history, politics, and economics more easily discern barriers to medication compliance and treatment.

After the session, Hahn further discussed the importance of presence in the context of competing demands for focus on electronic reporting. Hahn encouraged clinicians to see their patients in the details of the patients’ hands, to see their patients in the context of the room, to see their face fully, to value the history they wear, speak, and bear—these are all of value to patient visits. The conversations generate recall and let clinicians more fully populate the medical record, she said. Notes can serve as triggers for conversations. Quality reporting is improved.

During the presentation, Hahn spoke of the act of listening as providing attention to self and other. Clinicians who pause outside a patient’s door before entering acknowledge their work as vital and important and each patient as their focus. These clinicians are more likely to connect with patients and have an impact on their health.

There was consensus in the room with Hahn’s statement that all staff members need to be engaged in seeing the patient. Questions must be asked not to the computer screen but to the patient’s face. Taking notice of patient responses can trigger conversations that speak to the underlying barriers to health rather than the presenting problem of illness.

Hahn called on clinicians to be contemplative, curious, collaborative, and creative. Patient—provider relationships centered on the larger human condition are often less likely to be plagued by challenges with compliance, adherence, and follow up. Provider productivity is only sometimes compromised in these relationships: patients value provider time, show up on time, and are less likely to be no shows; providers waste less time clarifying patient responses with full attention to the patient; and quality drives the patient–provider encounter.

Hahn encouraged the audience by reminding us that patients who have developed relationships with a healthcare provider are more likely to set and meet health goals. “Health” and “care” are the active verbs in relationships where clinicians and patients value and engage in conversations regarding course of action, toxicity, and personal achievement. This is not soft science: Humanities are the essence of the patient—provider relationship.