For eight of the last days of his life, psychiatrist William Gruzenski, a patient in intensive care, was allowed to see his wife Jackie only during tightly limited visiting hours–a restriction she found “very cruel.” Moreover, the hospital staff ignored his request to address him as “Doctor.”
This bad experience was the focus of a commencement speech given at Yale Medical School earlier this year by Don Berwick, now the director of Medicare and Medicaid. Berwick called on his new fellow physicians–including his daughter Jessica–to temper the massive power they will wield over people’s lives.
What is at stake here may seem a small thing in the face of the enormous health care world you have joined. It is as a nickel to the $2.6-trillion industry. But that small thing is what matters. I will tell you: it is all that matters. All that matters is the person.
Berwick spoke eloquently at Yale of the need for compassion in medical care. He said that physicians aren’t just clinicians:
[N]ow I will tell you a secret–a mystery. Those who suffer need you to be something more than a doctor; they need you to be a healer. And, to become a healer, you must do something even more difficult than putting your white coat on. You must take your white coat off.
There is little to add here to this appeal to humanitarianism in medicine–except that Berwick’s speech perpetuates the notion that physicians have the power. It suggests that patients are mere recipients of physicians’ advice, care, and communications.
But patients have to be more than the passive twin in a power relationship. It’s the patient who can signal whether the physician should be paternalistic or subordinate, act authoritatively or humbly, rigidly enforce rules–like excessive limits on visiting hours–or show great flexibility. Patients, too, have power, and they have influence.
Of course, in the Gruzenskis’ situation, the hospital apparently was tone-deaf. There, the patient and family might have done better to appeal above the oppressive unit nurse’s head to the hospital administrator, attending physician, or chief nurse executive. After all, most critical care units abandoned strict limits on visiting hours decades ago, and there’s no excuse for refusing to address a patient properly.
In general, though, physicians tend to take their cue from patients. Sit there like a plant, and you’ll just be watered, fertilized, and pruned. Engage in conversation meaningfully–you don’t have to be brilliant, just active–and you’ll be treated as a human being, more likely than not. It’s your call.
One final word: Berwick is the health care quality guru whose appointment in July cheered patient advocates. But, as a victim of partisan sniping, he now holds the incredibly important post of Administrator of the Centers for Medicare and Medicaid Services on only an interim basis. A little more than a year from now, he could be gone.