Compassionate Care Is Being Replaced by Institutional Care

The following is adapted from Called to Care.

My first role as a physical therapist was treating soldiers. These were patients that placed their full faith in the practitioner’s hands so they could diligently and quickly return to the field and fulfill their mission. The immediate feedback in terms of outcome and gratitude from these loyal soldiers enduring my early career in the US Army confirmed and solidified my decision to become a PT. As I entered the private practice world in the late 1980s, these same intrinsic motivators remained high for many years — until significant systemic changes began to derail the motivation of myself and others.

There have been two major occurrences in healthcare that, in my opinion, have had undesired effects for most providers. For many of us, these occurrences have reduced our calling to purposeful work and generated unprecedented levels of attrition, burnout, and disengagement. Over the past several years, in an attempt to make healthcare more efficient, various “process improvements” (excessive documentation, regulations, and a variety of other hoops and ladders) have replaced time spent with patients. External studies have documented that as much as 25 percent of a provider’s time is not spent with a patient. Our internal studies show that for physical therapy encounters, the time spent away from patients is even greater. This time is now spent on unrelated but required administrative and insurance tasks that distract from provider–patient relationships and generally make healthcare worse for everybody.

In this era of enormous societal change, the pressure is now on healthcare executives to identify, adapt, and configure relevant healthcare technologies to yield greater efficiencies, reduce costs, manage greater transparencies, and cope with an environment now beset by rules, regulations, and insurance requirements. In 2014, the Physicians Foundation conducted a survey which received responses from 20,088 medical doctors and was reportedly the largest and most comprehensive survey of physicians as of that date.

The survey contained some remarkable results:

• Over 51 percent of respondents were pessimistic about the future of healthcare
• 38.7 percent of respondents reported that medicine and healthcare were changing in such a way that they planned on accelerating their retirement plans
• 50.2 percent indicated they would not recommend the profession to their children
• 28.7 percent of respondents said they would choose a different career if they had to do it all over again
• Physicians noted that they were spending less time on patient care because paperwork was consuming 20 percent of their time
• Over 55 percent described their professional morale and feelings about the state of the medical profession as negative

The move toward and emphasis on evidence-based practice has also had another unintended and unfortunate consequence: providers now all too often focus excessively on techniques and proven interventions while overlooking cognitive or tacit knowledge skills — like how empathy, listening, communication, and collaboration can also affect healthcare outcomes. This unbalanced approach furthered my desire to put humanity back into healthcare and share what the research has to say about the so-called “soft” skills in medicine.

As a result of so many changes, compassionate care is all too often being replaced by institutional care characterized by electronic medical records (EMRs), coding, and algorithms. This is an unintended consequence of the focus on evidence-based practice, EMRs, and compliance, and it has resulted in provider burnout and patient dehumanization as demonstrated in the survey results.

Provider burnout impairs patient outcomes, and dehumanization denies distinctively human concern for another human being — particularly through the practice of depersonalization. First identified by the renowned psychoanalyst Isabel Menzies Lyth in 1960, depersonalization is manifested, in part, by the referencing of patients not by name but by disease.

It’s time to promote and reinvigorate practitioners’ focus on compassionate clinical care and renew the purpose and meaning that brought so many healthcare practitioners to their professions in the first place. In short, we need to bring humanity back to healthcare and move away from the institutionalized model that has distracted us from our true calling: care.

For more advice on compassionate care, you can find Called to Care on Amazon.

Dr. Larry Benz, PT, DPT, OCS, MBA, MAPP, is the co-founder of Confluent Health, a network of physical therapy and related healthcare companies dedicated to delivering exceptional care, educating and developing highly effective clinicians, strengthening private practice, reducing healthcare costs, and elevating care in healthcare. A frequent lecturer at Physical Therapy programs, national conferences, and MBA schools throughout the country, Dr. Benz graduated from Bowling Green State University trained at Baylor University and the University of Pennsylvania. He is a nationally recognized award recipient for his expertise in private-practice Physical Therapy and occupational medicine. As the co-developer of Jacmel Rehabilitation, Dr. Benz and his colleagues at Confluent Health and other various organizations have built a sustainable physical rehabilitation clinic in Haiti. For more information, please visit PThelpforHaiti.org and CalledtoCarebook.com.