Doctor appeals to colleagues: Do more than problem-solve
Psychiatrist David Kopacz works at the Veterans Affairs primary care clinic in Seattle and is an acting assistant professor of psychiatry at the University of Washington. His new book, “Re-humanizing Medicine" (Ayni Books, 2014), suggests that medical providers often lack the capacity to engage with patients beyond a problem-solving level, which ignores other factors vital to health. He discussed the book and his ideas with HSNewsBeat writer Brian Donohue.
What’s the main thrust of your book?
The lack of attention to the whole person of the physician in medical training and practice. We hear a lot that we’re supposed to provide patient-centered care, but a lot of our training is really reductionistic and teaches us to be technicians.
The physician as technician?
Yes, that’s a lot of our training. It’s how a physician provides service to different people in the same way, like an assembly line. You lose compassion as well as attention to spirituality and emotion and other factors important for health.
Do you see this as a development of the recent past, or has this deficit always existed?
A bit of both. The recent push toward evidence-based medicine results in more predictability and scientific precision in what we do, but it blinds us to other aspects of human interaction.
I also think that becoming objective, cold, detached, rushed – all those are occupational hazards of medicine.
In medical school I also learned it was more important to appear to know what you’re doing, even if you’re wrong but close, than to acknowledge you don’t know something. We’re on rounds, the attending asks about the patient’s potassium level. I didn’t know. The intern said a number, which I found later to be untrue, but he got credit in the moment for “knowing.” He was assertive and appeared to know, and I think that behavior is rewarded.
Medical education and science place a high priority on certainty, yet human beings are very complex. Physicians develop this ability to hone in and narrow down a health condition. What I’m arguing is that we should recognize this ability as one technical skill, and we should also value the human ability to zoom out, to engage in these other dimensions of heart and spirituality and emotion. We’ll be better technicians if we listen to people more closely.
Isn’t it fair to say that patients these days are more apt to prioritize competence and solid information over things like bedside manner and attention to spirituality?
I think it’s a balance. There is a downside to moving too quickly from person to symptom. A patient’s talking and I can break down what they’re saying and identify a symptom, then focus on that symptom … start looking on the computer for information about it. If my listening skills and hunch are correct and I hone in on the right information, that’s good for the patient. But if I feel rushed and jump on the first thing that sounds like a symptom, or give too much weight to the patient’s self-diagnosis, it’s possible that I stop hearing the person and miss something important.
Also, when pharmaceutical companies market directly to consumers, that doesn’t always encourage doctors to make objective decisions, even though we say medicine is getting more evidence-based.
Is there one main thing that you propose physicians and their teachers do differently?
As doctors we are trained in a reductionist model, to reduce things to biochemistry and then to intervene in a biochemical way with a pharmaceutical. I’d say we also need to train in awareness of other dimensions of health.
Do you have much hope for change in this regard?
I do, actually. In the United States, organizations like the Institute of Medicine are saying we need full-scale reform in the way we provide healthcare. Nationally at the VA there is an Office of Patient Centered Care and Cultural Transformation. So there is an awareness that we need to change the culture of medicine.