A Patient, Not a Person???

Medicine’s bad habit of dehumanizing patients

In medicine, patients are often treated as slightly less than human—sometimes unintentionally, and sometimes to help doctors do their jobs. Making patients into people again while still giving them the best treatment is not a simple task.

As though being in the hospital were not bad enough—there is the hospital gown, gaping open in all the wrong places; the efficient but unpleasant tests; the doctor too absorbed in your chart to make eye contact—the impersonal routines and small humiliations of medicine can leave patients feeling demoralized. But more than that, these practices unintentionally dehumanize patients, treating them as not fully capable of thinking, making decisions, or—as many a patient will wincingly agree after a particularly brusque exam—feeling.

Adam Waytz, an assistant professor of management and organizations at the Kellogg School of Management, and Omar Sultan Haque, a psychologist and physician at Harvard University, catalogued six practices that lead to dehumanization in hospitals and suggested possible alternatives that would diminish it without compromising care.

Cataloging the Causes
The causes of dehumanization in medicine, Waytz and Haque found, fell into two categories. Some were simply byproducts of the clinical system. One such cause is deindividuation, the practices that take away identifying characteristics and make both doctors and patients seem less like individuals and more like part of larger groups: legions of doctors all donning white coats, gown-wearing patients in rows of identical beds. The patients all begin to blend together, to seem less like individuals with distinct concerns. And as for the doctors, Waytz says, “this sea of white coats loses their individuality,” making them feel less personally responsible for their patients and their actions.

Patients are dehumanized, too, by what is known as impaired agency, a lessened ability to think or plan for oneself. Many patients’ conditions—whether they are in a coma or simply groggy-headed from medication—keep them from making all the necessary decisions.

The dissimilarities between doctors and patients contribute to dehumanization, as well. People tend to think of people less like themselves as being less human, social psychologists have shown. Doctors are healthy and operating in a situation in which they are comfortable and competent. Patients are, of course, sick or injured—and what’s more, “anyone who’s going to the hospital or the doctor’s office is there precisely because they lack the ability to make themselves better or self-diagnose,” Waytz says. The dynamic of a healthy person in power and an ill one needing help sets up a dehumanizing relationship.

Unintended Consequences
Deindividuation, impaired agency, and dissimilarity do not serve a particular purpose; they are side effects of the way the medical system is set up. Other causes of dehumanization, however, can actually help healthcare workers handle a tough job. “Despite dehumanization having negative effects on patients’ reports of the quality of care that they receive, it has some benefits for nurses and doctors,” Waytz says. Earlier studies found that dehumanizing patients can reduce healthcare workers’ feelings of burnout, and let them cope better with the constant pain and illness they see.

The dynamic of a healthy person in power and an ill one needing help sets up a dehumanizing relationship.

When diagnosing a patient, physicians often think of the patient not as a person, but as something made up of interacting systems, a practice called mechanization. Thinking of a patient as the sum of their parts—cardiovascular system, biomarker levels, tumor cells—can help doctors pinpoint what is wrong and determine how to fix it. But it also means thinking of patients as mechanical objects, made up of interacting systems, rather than as people.

Doctors also show less empathy to patients’ pain than non-doctors do, suggesting they are not thinking of patients as having fully human feelings. A recent neuroimaging study found that, when watching a patient get pricked with a needle, physicians showed far less activation in brain areas linked to empathy. This lessening of empathy, Waytz and Haque say, likely comes from medical training. Since feeling the pain of each patient would be overwhelming, future physicians are encouraged to control and mitigate their responses to other people’s pain, freeing up valuable mental resources for diagnosing and treating patients but again treating them as somewhat less than human.

Physicians pledge to do no harm, but many medical procedures—surgeries and setting bones, for example—are painful. This leads to moral disengagement in which doctors distance themselves from patients so that willfully inflicting pain on another person—something that would be abhorrent in other circumstances—becomes permissible.

Finding a Fix
Once they had identified the causes of dehumanization, Waytz and Haque proposed potential fixes that could lessen it. Since they hope that these fixes could be tried and tested in clinical settings, Waytz says, “these are not things that would cost any money. They’re just practices, and really minor practices.”

For the causes of dehumanization that do not serve a purpose, Waytz and Haque propose small tweaks that would keep both doctors and patients from falling into that mindset. Changing practices that usually make patients and doctors anonymous members of larger groups—having doctors not wear identical coats, for instance—can humanize both groups by making their individuality apparent. Letting patients make more decisions or giving them responsibility can increase their agency; an earlier study found that caring for a plant or taking on similar tasks helped patients at a nursing home live longer. Focusing on patients’ humanity rather than labeling them as their disease—calling a patient “Mr. Smith, who has diabetes” rather than “the diabetic in room 341”—can remind doctors how much they and their patients have in common.

Several other practices could help humanize patients without lessening healthcare workers’ ability to do their jobs, Waytz and Haque suggest. Saying a sentence or two about a patient’s background, job, or family life—information often already available on their chart—at the beginning of hospital rounds, for instance, could remind doctors of the patient’s humanity. To increase empathy without making it difficult for doctors to operate or perform painful procedures, medical training could help them learn when empathy is necessary and when detachment is. A surgeon could empathize with a patient during an office visit, then regulate his emotions and become more detached in the operating room.

Making Up Our Minds

Waytz hopes to soon test these practices in a clinical setting. “We proposed these interventions based on the psych literature and based on Omar [Haque]’s experiences as a physician, but future research has to determine whether our suggestions are really effective,” he says. Under the unique demands and situations of hospital life, some interventions might prove infeasible, while others could have a big effect for little effort. To do those tests, Waytz says, “we have an open call for anyone in the medical world who would like to collaborate with us.”