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The Factory Farming of Patients

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When did we decide medicine was more about making money than making people well?

Yesterday I went for my annual mammogram. I go to the same medical imaging center each year. I know the drill -- take off shirt and bra, put on a thin blue robe open to the front. Wait in the communal area with the brown vinyl overstuffed chairs.

But yesterday, this clinic's core technical ability -- imaging -- was noticeably absent from the interactions between the staff and patients.

None of the receptionists and technicians actually saw me that day. Nor as I could tell did they see any of the other women who sat quietly, flipping magazine pages, hoping desperately to receive no bad news.

The indifference began at the reception desk. A young girl sitting behind a high ledge asked for my birth date to identify me, never looking at my face. Unfortunately, on this day, that indifference culminated in what I now think of as an example of "exquisite awfulness" for one woman.

While waiting in the communal area, pale and frightened, almost hyperventilating, she beseeched me, "Do I have cancer? The girl told me to wait here. They have to look again. I must be sick, mustn't I? Ay, Dios mio! Dios mio!"

At this clinic, most women have a sonogram after their mammogram. When breast tissue is dense and fibrous a mammogram can't clearly show the presence of calcified cells, tumors or cancer.

Yet, the mammography technician did not tell this to the now hyperventilating woman. She told her only to sit down again in the waiting room for another test.

Increasingly, I experience "care" being filtered out of health care.

We now revere technology and machines. Plus, institutional guidelines compel providers to push as many patients through their offices, in assembly line fashion, as quickly as possible.

This factory farming of patients -- our focus on profit and efficiency at the expense of patients' welfare -- is soul-crushing, and not just for patients. Medical professionals have become disconnected from their own humanity and providers and patients have become disconnected from each other.

In providers' hurriedness, the small kindnesses are falling away: a smile, a handshake, a few warm words, making connection. As care drops out of health care we are paying for it; we are sowing greater dis-ease.

Hearing my name called by the technician for my mammogram, I clutched my flimsy gown to keep it from flapping open while I raced behind her; she was already 20 feet ahead of me down the corridor.

When the procedure was over, I got a hand wave to the room I was to sit in next. The same hand wave stockboys use to indicate where the item you just asked for is. But, inevitably you are left to look for it yourself.

I am not suggesting, by any means, that we give up our medical and technological advances. I am suggesting that in our esteem for hardware, that we do not forfeit "heartware." That we recognize tending to each other, particularly when we are at our most vulnerable, is the very meaning of care. And that care is, in and of itself, healing.

Bernard Lown, M.D., winner of the Nobel Peace Prize, writes in his book, The Lost Art of Healing:

A 3,000-year tradition, which bonded doctor and patient in a special affinity of trust, is being traded for a new type of relationship. Healing is replaced with treating, caring supplanted by managing, and the art of listening is taken over by technological procedures ... Patients crave caring, which is dispensed largely with words.

If you doubt that just a few moments exchange with another person can raise one's spirits, a behavioral experiment conducted on the Chicago subway confirmed this truth.

As reported in the New York Times article "Hello Stranger," those people who engaged with their seatmate in a few minutes conversation on the subway -- that bastion of don't look at anyone and don't under any circumstances talk to anyone -- said it made the ride more positive and pleasant.

Further, while most people think our well-being is mostly dependent on our closest ties, the study reported that people felt happier on days when they had more interactions with simply anyone.

Dr. Rachel Naomi Remen, who created The Healer's Art, a national curriculum in 70 medical schools for students to explore service, compassion and healing writes how medicine has lost its heart.

In her book, My Grandfather's Blessings, she tells a story of three stone cutters. Each day all they do is cut blocks into rocks. When someone asks the stone cutters, "What are you doing?" the first yells furiously, "You idiot, you see what I am doing! I am given a rock and I cut it into a block!"

The second says gently, "I am providing for my family, giving my wife and child a comfortable home and food to eat." The third beams and says, "I am building a great cathedral where people who have gone adrift and are afraid will be able to put down their burden and let God shine into their souls."

What we do matters and how we see our work matters. It guides how, and the spirit with which, we do it. The factory farming of patients is not medical professionals' choice, it is the result of a health care system that too often values profit over people. Profit and care must not come at the expense of each other, they must be combined.

We must also train medical students that good medicine is both the result of modern technology and the simple exchange of comforting words or holding someone's hand.

And we must help those who went into health care reconnect with, and reinvigorate, their original desire to help others. So that they can stitch back into their work the essential fabric of service that was once woven into health care.

After all, we know in our hearts that being seen by our fellow human beings is as necessary to good health as being seen by an expensive imaging machine.

Riva's latest book, Diabetes Dos & How-Tos, is available in print and Kindle, along with her other books, 50 Diabetes Myths That Can Ruin Your Life and the 50 Diabetes Truths That Can Save It and The ABCs Of Loving Yourself With Diabetes. Riva speaks to patients and health care providers about flourishing with diabetes. Visit her websites DiabetesStories.com and DiabetesbyDesign.com.

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