These patients and families look to their clinicians and caregivers to provide them with lifesaving medical care. But they also look to them for information, reassurance and compassion. Unfortunately, they don’t always receive it.
In fact, even while patients are being provided with high quality technical care, they are often dehumanized in subtle ways — stripped of their clothing; called by their condition rather than their name; subjected to tests and exams they don’t understand, by doctors they don’t know.
Why does dehumanization happen? What is the impact on patients? How can we create change?
Finding answers to these questions is what motivates Dr. Samuel Brown, director of the Center for Humanizing Critical Care at Intermountain Healthcare.
The Center brings researchers and clinicians together to focus on helping patients and family members make it through life-threatening illnesses and injuries with their humanity and dignity intact.
How Medical Dehumanization Happens
Dehumanization happens when you deny people’s human qualities, such as personality, reasoning and spirit. Extreme cases of dehumanization occur during war or genocide, and these are often deliberate. However Dr. Brown has found through research that most dehumanizing acts in medical settings occur unintentionally.
An overwhelming majority of health care professionals are caring people who are committed to helping others. That is why they have chosen a medical career. But being a clinician often requires complicated analytical thinking. And awareness of a patient’s humanity may become a distraction that affects their ability to do their job.
Additionally, some critical care professionals unconsciously “turn off” their empathy and dehumanize patients to protect themselves from sadness associated patients patients’ death, a distressingly common outcome from an intensive care unit stay. This psychological shield may enable some medical providers to continue to care for critically ill and dying patients day after day.
Dr. Brown’s primary goal is to develop approaches to critical care that acknowledge and respect patients as human beings, while still protecting caregivers from added stress and burn out.
The Impact on Patients and Families
Many commonly accepted critical care treatment practices result in unintentional psychological harm and suffering. Patients may feel abandoned, disillusioned, and confused. Many recovered ICU patients experience levels of PTSD similar to those of combat veterans.
The impact is physical as well as psychological, and can affect the patient’s outcome and ability to heal.
Bringing Humanity Back
There are no simple solutions to changing the culture of ICU patient care, and further research needs to be done. But under Dr. Brown’s leadership, Intermountain has already taken steps toward improvement.
Dr. Brown encourages medical practitioners to observe what he calls “The Dinner Party Rule,” treating each patient like he or she is the respected host of a dinner party. These basic guidelines include:
- Knock before entering. This simple gesture offers patient’s some control over their personal space and privacy. Providers should avoid entering a patient’s hospital room or hospital bay without knocking (or asking permission) first.
- Ask what a patient would like to be called. Learning what a patient wants to be called is an important part of acknowledging them as an individual. Providers should first address a patient by the respectful title of Mr. or Mrs., followed by their last name. Then, they should ask the patient what name he or she would like to be called.
- Treat coma patients as if they are listening. Although some providers feel awkward talking to coma patients, it is important to treat them as though they are awake, by asking permission to touch them and addressing them appropriately.
Call the Experts
Physicians don’t hesitate to call experts to help solve a medical problem. The same principle should apply to the more personal aspects of care. At Intermountain, the “experts” on an individual patient— their loved ones—are involved in numerous stages of patient care, from life support to physical therapy. The result is improved patient engagement, better morale, and better outcomes.
On an ongoing basis, one of the challenges of making critical care medicine human is finding the appropriate balance. Patients should be treated humanely and with dignity, while medical providers need to psychologically care for themselves so they can continue to do their jobs.
Dr. Brown believes that the answer lies within our ability as humans to empathize. By tapping into their human capacity to think, to care and to honor, medical professionals can begin to find the balance they need to provide respectful, high-quality critical care.