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How Women Physicians Must Change the Patient Care Paradigm in the War Between “Relationship” Based and “Evidence” Based Medicine

physcian as healerA war is brewing in the House of Medicine.  It’s a war of philosophy based on how we physicians approach our patients–the people who come to us to be cared for and to be cared about.  These people who come as patients to the physician as healer.  A healer who also has a wealth of scientific knowledge which can be used to stamp out disease and bring long, healthy lives to many more people than ever in the history of humankind.

There is no doubt that science has allowed us to save babies who have emerged from their mother’s womb months before the world is ready for them.  It is that same science that has allowed centenarians to become commonplace, many of whom are highly active.  And it that same science that has created technologies that have almost made it moot to actually touch the patient for a physical examination and now even an operation where we wound to cure.

But it is also this science, based in “evidence” that is increasingly creeping into and undermining the patient-healer relationship.  And it is not the science/evidence per se that is potentially harmful, but rather the fact that it is allowed to supplant, not supplement, the core of what should be a sacred relationship.  It crowds out the physician as healer who cares about the patient as unique person.

Sticking with evidence alone, we lose sight of the personal.  We look at images, numbers, and “objective evidence.”  Patients want us to care about them as human beings.  They want us to hear their voices, their concerns, their fears and their pain.  Things not easily quantified and objectified.  It’s a tall order, I will admit, but it is not impossible.

So how is it up to women to change this patient care paradigm?  How do we make sure the shift is not too far to the evidence side and too far away from the healer side?

Women are brought up with a different mind set.  Relationships that share intimacies are very important to us as we grow up.  And even though our schooling and training acculturates us to the medicine as science, many of us have rebelled against only doing business this way.

Here’s how:

    • We take longer with patients.
    • We order fewer tests.
    • We do fewer procedures.
    • We interrupt less.
    • We ask more.
    • We hear more.

And for all of this we are called less productive.  We are devalued for our style of relating to the patient, of tackling their problems.

The naysayer might ask, “Is there any proof that this approach will make a difference?”  Yes, scientifically speaking there is the placebo effect, which can be measured and can be very strong.  And so we must find other ways to show that our patients benefit from the healer in us so we can help to restore them to sound body and mind.

We have entered an era where evidence based medicine is constantly cited as the panacea for all that ails our healthcare system.  Clearly it is not.  It is limited because people are so uniquely different.  And it is up to us to recognize each person’s unique humanity and try to connect to them so that they have hope, positive energy, and the feeling that their problems will at least be heard, and in a most perfect world, solved.

So, as relative newcomers to the House of Medicine, we women have to re-emphasize the relationships that are necessary to form if we are to make the evidence most effective.  Next steps:  study these relationships, learn how women physicians work best, define our attitudes about patient care, and redefine what constitutes “productivity” for physician healers. And then there will be war no more.

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