When “WHY” goes missing!

February 27, 2019

By – Dr. Devendra Tayade
(Aravind Eye Care System)

In the last few decades, healthcare has made a lot of  progress. Earlier, the healthcare system was quite simple- a doctor and a patient. Over  time, as the demand for medical care increased some more components started getting added to it. From a point where a doctor would carry all he needed in his suitcase and visit his patients whenever needed , and a clinic was essentially a small part of his home, now the same patient has to make  an appointment to see a Doctor and has to visit a big hospital, where before meeting the doctor he has to cross many layers of people and processes.

Healthcare has evolved and a lot of things have changed. New technology has come in which has made complicated procedures relatively easier and possible. Introduction of checklists and standard operating procedures have made an attempt to ensure elimination of  errors and have consistency in delivery. From the times of personal care/ customization to the current era of standardization, healthcare has undoubtedly made humongous progress. And this (standardization) was needed, for little available HR to take care of huge patient load.

But the balance which needs to be there between care/ empathy and standardization seems to be more skewed towards the latter. When we lose the purpose for which systems were put in place i.e. to provide care to as many patients as possible, actions tend to become more mechanical than thoughtful.  This is when, the checklist, which was made to avoid any mistakes becomes a tick list and creates only hindrance in the work of providing care.

Every now and then we stumble upon experiences which have brought our attention to this aspect which is going out of healthcare very rapidly i.e. element of care and empathy.  Not only patients are losing their faith, but doctors, who once upon a time wanted to take up this profession for the joy of making a difference to someone’s life, are finding it difficult to wake up every day  with same energy and motivation.

In the following two articles, two doctors share their first hand experiences when they had to be on the other side of the table.

  1. Heart and Sole — Of Metatarsals, Meaning, and Medicine – www.nejm.org/doi/full/10.1056/NEJMp1815627
  2. Doctors Revolt – www.nytimes.com/2018/02/24/opinion/sunday/doctors-revolt-bernard-lown.html

While these articles bring out what can happen if we take out “why” out of anything, they also make us reflect and question – While standardizing the processes to achieve scale, how can we still maintain the component of empathy and care? How do we bring back the joy of doing something beautiful?

Answers are difficult but we must begin the quest to find them before things get out of our hands.


3 responses to “When “WHY” goes missing!”

  1. Thank you, Devendra, for framing these important issues in your message and for reinforcing linked articles. You correctly note that action is required to understand and address the increasingly ‘utilitarian’ approach to medical procedures. We need to examine and experiment on how to put the focus on caring. Promoting examples of turn-arounds and their impact on patients can care givers can be powerful.

  2. Avatar for ARNAZ DALAL Satish Parthan says:

    Thoughtful points, Dr.Devendra… It raises both philosophical and practical questions.

    To add to the discussion:

    Answers to the “WHY” questions, as in the title of this column, can often be found by asking the converse question, viz. “WHY NOT”? …. [As the writer George Bernard Shaw had famously said (Quote): “You see things and say “WHY”… But I dream things that never were; and say “WHY NOT” !!!]

    The visionary founder of Aravind Eye Care System Dr.V had asked the “WHY NOT” questions, to resolve many of the “WHY” questions raised in this column… The results are well-known to healthcare policy-makers and providers across the world… Aravind has convincingly and consistently demonstrated that a healthcare system can be both “HIGH-TECH” (including standardization and checklists!) as well as “HIGH-TOUCH” (community-spirited, compassionate).

    Yet, a fundamental “WHY” question remains unresolved 🤔

    WHY have healthcare systems across the world NOT been able to adopt/ adapt a model which has been implemented successfully by Aravind… for so many patients… since so many years ?

    Perhaps your next column could probe the same issues raised here again… this time discussing how proven solutions could/ should be made to work for everyone…

    The title of the next column could then be:

    “When WHY NOT goes missing” !!!

  3. Avatar for ARNAZ DALAL Larry Hulbert says:

    Thank you for sharing this thoughtful and thought provoking article. Like any piece of good writing, it raises even more questions than it addresses. For example, in this day and age of high tech, high volume, highly efficient systems of providing care, how can providers re-claim that sense of wonder, inquiry and satisfaction in knowing that what they do many times every day is life giving to many patients. How can those of us who work in support of providers reinforce this message rather than get lost in the many administrative tasks that can easily take up most of our energy and spirit? And many more questions come to mind.
    Keep writing and inviting the discourse you have initiated.
    Larry Hulbert

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