I recently was astounded to find quite a bit of “woo woo” language in the Hippocratic Oath that suggests empathy is part of true healing. For example, the Oath says:
“I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon’s knife or the chemist’s drug.”
Who would have thought that warmth and sympathy could potentially be more important than the surgeon’s knife or a prescription drug in healing?
Considering the myriad reimbursement models emphasizing production and invasive procedures (rather than time to develop relationships and trust) and the priority given to drug therapies, our current healthcare “system,” does not believe this to be the case.
“I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person’s family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick.”
Could there possibly be holism, or taking all of a patient’s physical, mental and social conditions into account during the health encounter, in the Hippocratic Oath? Could it be that episodic and siloed intervention-based care is not the way to truly position individuals, families and communities for better health?
To date, most existing physician practices, hospitals, physician hospital organizations (PHOs), as well as new “innovations” in healing such as patient-centered medical homes (PCMHs) and accountable care organizations (ACOs) are not truly embracing holism in healing. They are not designed to focus on the patient along with the family system and the economic impact to the family due to a specific health crisis. These existing organizations and “innovations” do not currently nor intend to integrate the physical, mental, environmental and financial drivers impacting patients, families and communities. Apparently holistic care, which according to the Hippocratic Oath focuses on the person (not the disease), is still “woo woo” in the eyes of our staid medical system.
Again, based on current and proposed reimbursement models (where only small portions of revenue are tied to outcomes via Pay for Performance (P4P) models), short office visits, a lack of true integration of even mental health with primary care (never mind social and economic factors), and rotating practitioners and extenders, it appears that in fact holism is not part of the current healthcare “system” nor future “innovations.” And yet … it is very clearly part of the Hippocratic Oath physicians pledge to honor.
Here’s a third example:
“May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help.”
“The joy of healing?” Have you talked with a physician recently?
As shared previously in “Tough to focus on patient care and productivity at the same time,” a physician friend in a local healthcare system recently told me that he’s so tired and burnt out that he’s thinking of leaving medicine. As a primary care physician, he feels his role has moved away from being a healer and toward becoming a production worker.
Rather than focus his energy on ensuring that his patients are best positioned for optimal healing, he feels pressure to ensure that he’s triple-booked every 15 minutes so he generates the required 30 “relative value units” (RVUs) per day and thus earns his salary.
He also had to maintain ~5,000 active patients in his panel and told me that he actually truly knew very few of his patients.
Whatever happened to “joy in healing”? Neither the current system nor the new “innovations” are set up to truly focus on the health and satisfaction (the joy) of the physician (the healer). The design is still based on maximizing financial return on investment and productivity, not maximizing health status improvement and physician satisfaction. And just try to discuss “the joy of healing” in most healthcare organizations and watch out. … Be prepared for laughter, being called “woo woo” and slacker, and marginalization as a healer.
Hippocrates and the subsequent evolution of the Hippocratic Oath truly understood healing. Call it “woo woo”, call it squishy, call it warm and fuzzy … call it what you will. But as the Oath illustrates, warmth, sympathy, understanding, holism and joy in healing are critical factors required for any optimal healing model.
Physicians have sworn to this Oath and they, along with us healthcare leaders, are obligated to create systems that best position healers to honor these obligations.