Is modern medicine ill with dehumanization?
New article offers a diagnosis, unveils its causes, and prescribes a humanizing cure
"Anyone who has been admitted into a hospital or undergone a
procedure, even if cared for in the most appropriate way, can feel as
though they were treated like an animal or object," says Harvard
University psychologist and physician Omar Sultan Haque. Health care
workers enter their professions to help people; research shows that
empathic, humane care improves outcomes. Yet dehumanization is endemic.
The results can be disastrous: neglect of necessary treatments or
prescription of excessive, painful procedures or dangerous drugs.
What are the causes and effects of dehumanization in medicine? And what can be done about it? In
Perspectives in Psychological Science,
a journal of the Association for Psychological Science, Haque and
co-author Adam Waytz at the Kellogg School of Management of Northwestern
University synthesize diverse literatures to distinguish when
dehumanization is useful from when it is not. Then they recommend
"simple, cheap, and effective" changes to "make medical institutions
more humane and ethical, as well as efficacious in the service of
improved health," says Haque.
The structures of institutions and the psychological demands of
providing care can cause professionals to treat patients as less than
human. "Deindividuation"—doctors as a sea of white coats; patients as
half-naked bodies in smocks, identified by their disease or procedure
("the gallbladder in Room 38")—allows staffs to avoid taking
responsibility for each patient. "Impaired patient agency" refers to
medical staffs' treatment of patients as incapable of planning their own
care, which is both infantilizing and demoralizing.
"Dissimilarity"—hierarchies of power, differences of race, class, and
gender between staff and patients—have roots outside the hospital.
Nevertheless, they cause miscommunication and alienation, even
maltreatment. None of these practices serves good medical care.
More complex are dehumanizing practices that may aid care. Diagnosis
and treatment might necessitate "mechanization"—breaking the body into
organs and systems. Scaling back empathy can diminish staff stress and
burnout. Even moral disengagement can be adaptive. From giving a shot to
slicing into the flesh to perform surgery, medical care often requires
inflicting pain or invading the boundaries of the body in violation of
deeply held human taboos. And patients may die after even the best of
care. For the professional, guilt could be paralyzing.
Still, the authors argue, dehumanization is useful only in "specific
contexts," such as acute care. Waytz says, "Dehumanization's
functionality varies wildly across specialities from pediatrics to
orthopedic surgery, so future research is needed to determine when
dehumanization is most prevalent and most detrimental." In the meantime,
the authors offer numerous humanizing fixes: Call patients by name, not
numbers; discourage labeling people as diseases; personalize hospital
rounds and pre-surgical preparation; eliminate opaque surgical masks;
affix photos to CT scans and biopsies. Include patients in care
planning. Let them choose their gowns—and design those gowns so they're
no so humiliating. Increase physician diversity and hire people with
good social skills. And, for med schools, perhaps most radical:
Eliminate the "white-coat ceremony" when graduates don the mufti of the
elect.
Finally, "we should train medical professionals to think of
themselves as mortal – sharing a common humanity and vulnerability with
their patients," says Haque. Although dehumanization can be useful,
"even functional dehumanization should be viewed like a potent,
salutary, but dangerous drug that can have disastrous side-effects" when
overprescribed.
