Celebrating the Human in Hospitalist Medicine

This spring as part of an interview panel, a statement stood out that seemed completely ordinary at first. The candidate in question for our hospitalist program was answering how to best manage patient and family complaints. The applicant mentioned different approaches and delved into a story referencing a patient who complained that he had not seen a doctor in days while admitted to the hospital. Everyone on the panel chuckled, of course, the hospitalist was seeing the patient every single day. On my drive home that day, I could not help but wonder why this complaint has become so omnipresent. Often a deflection to a patient’s cognitive skills or certain medication side-effects is the easiest way to make sense of this irrational statement. But on a deeper level, it does not seem to explain the whole picture.

In its quest to provide better healthcare, the Centers for Medicare and Medicaid Services have incorporated patient satisfaction scores as a quality-of-care metric. Addressing patient complaints whether valid or not, sometimes feels like a hospitalist’s raison d’être. Unfortunately, it is becoming harder and more complex to realistically meet patient satisfaction goals. A 2023 Gallup poll indicated that Americans’ satisfaction with the healthcare system has declined 15% since 2010.¹ A majority of this is due to the COVID-19 pandemic. As patients and their families separated from each other due to quarantine regulations, the feelings of isolation and unhappiness grew exponentially. Alas, that sense of resentment has not dissipated.

The prevailing discontent is present on the physician’s side as well. A recent 2024 Medscape Physician Burnout Survey reported a slight improvement in burnout rates from 53% to 49%, however, the reasons for burnout remained consistent.² Absence of respect from administration, colleagues, and staff ranked as one of the topmost reasons. Lack of respect from patients was also in the top 10 causes for the last three years.²

This uncovers a strange conundrum. Patients who do not feel “seen” by their physicians, and physicians who do not feel “seen” by their superiors, colleagues, and patients. The author David Brooks calls it an epidemic of blindness and describes us living in the middle of a vast emotional, relational, and spiritual crisis. “It is as if people across society have lost the ability to see and understand one another”.³

There is evidence to support that claim. Social isolation and loneliness have become widespread in our country. One in four adults aged 65 and older feel socially isolated.⁴ The major factors that contribute to social isolation are chronic disease and long-term disability.⁵ This demographic segment is most frequently admitted under our care. 

It is vital to recognize the elements that brew this discontent and disillusionment. In recent years, the upsurge of technology and social media has caused a dehumanizing effect on us as a society. Additionally, the polarizing nature of current-day political discourse has made us increasingly partisan and bitter toward different points of view. It would be fair to ask if it is the society we live in that is to blame for these divisions or do we ourselves hold responsibility.

As I reflected further on this vexing question, my mind wandered to the interactions I had with my patients that day. Did I make eye contact? Did I sit down in their room while talking to them? Did I inquire about their emotional well-being? Did I take the time to get to know them as a person and not just as a patient? As the faces of those patients appeared before me, I easily recalled their medical conditions, treatment plans, and even specifics about their laboratory and imaging findings in exacting detail. However, it occurred to me that I was having a challenging time recalling the first names of my patients. 

My focus had been to make them clinically better and work towards getting them to their next level of care, whether it is home or a rehab center. In my mind’s eye, knowing them better as a person did not align with those goals. This begs the question: Is doing well on quality metrics like length-of-stay and readmission rates correlating accurately with patient satisfaction scores?

As my car approached home, the haunting piano introduction of the song “What Was I Made For?” from the Barbie movie came on the radio. Today the world, especially if viewed through the lens of social media, has begun to resemble something like a make-believe doll house. Our focus on the exterior, lack of real human connections, and a notion of life centered around superficial parameters, seem to closely resemble the world of Barbie land. In pursuit of these goals, something has gotten lost. Something which is essential for all humans to survive. 

I realized that I was ignoring the importance of that human experience. I was focusing on the medical problems, applying all my energies to resolve patient issues while forgetting the individual. The creation of that human connection is too important to be left to circumstance and chance. To quote the great theologian and human-rights activist Desmond Tutu, “My humanity is bound up in yours, for we can only be human together.”  

The solution to our often dysfunctional and inflated healthcare system is less dependent on complex structural changes. The solution lies in the simplest of things—our mutual humanity. If the physician surveys provide any guidance, it shows that we ourselves need this rekindling of humanity more than ever. We need to break out of our plastic doll boxes of Barbie and Ken, a default version of us molded by the system, environment, and conditions.

What we need is to be human again. That is what we were made for. 

 2024 National Hospitalist Day Contest Submission

Dr. Khan is a hospitalist at Williamson Medical Center in Franklin, Tenn.

References

1. Saad, L. American Sour on U.S. Healthcare Quality. Gallup. January 19, 2023. https://news.gallup.com/poll/468176/americans-sour-healthcare-quality.aspx
2. McKenna, J. Medscape Physician Burnout & Depression Report 2024. Medscape. 2024. https://www.medscape.com/slideshow/2024-lifestyle-burnout-6016865?icd=login_success_email_match_norm&icd=login_success_email_match_norm
3. Brooks, D. How to Know a Person: The Art of Seeing Others Deeply and Being Deeply Seen. 2023; 8:97. Random House. https://www.penguinrandomhouse.com/books/652822/how-to-know-a-person-by-david-brooks/
4. National Academies of Sciences, Engineering, and Medicine; Division of Behavioral and Social Sciences and Education; Health and Medicine Division; Board on Behavioral, Cognitive, and Sensory Sciences; Board on Health Sciences Policy; Committee on the Health and Medical Dimensions of Social Isolation and Loneliness in Older Adults. Social Isolation and Loneliness in Older Adults: Opportunities for the Health Care System. Washington (DC): National Academies Press (US); 2020 Feb 27.
5. The Loneliness Epidemic Persists: A Post-Pandemic Look at the State of Loneliness among U.S. Adults. The Cigna Group; December 2021. Accessed March 21, 2023. The Loneliness Epidemic Persists: A Post-Pandemic Look at the State of Loneliness among U.S. Adults | Cigna Newsroom (thecignagroup.com)