Patienthood vs. Personhood

For too long in the medical profession, we have referred to patients as “the diabetic” or “the schizophrenic” or “the addict” or “the bipolar.” Most physicians would say that this is just shorthand; we know that our patients are people. However, I believe that we need to apologize to all patients for this terminology. It dehumanizes. People are not defined by their illness. You are a person with diabetes or a person with schizophrenia, or a person struggling with addiction or bipolar disorder. Sometimes I think you, the patient, actually come to believe that the diagnostic label defines you. You begin to think of yourself as a schizophrenic before you think of yourself as a wife, husband, mother, teacher, friend, sister.  We in the medical profession need to stop this pigeonholing of our patients and you, patients, need to stop buying into it.

I sometimes wonder if this is primarily occurring because of the push to see more patients. As busy physicians, we have to focus on the problem at hand. Those of us who are employed usually have a target amount that we are supposed to bill each month.  That means seeing a certain number of patients each day. Those in private practice have overhead and malpractice premiums.  Some physicians see the electronic medical record as a barrier between patient and doctor. Patients may feel that the doctor spends more time looking at the computer than at them.  We are very focused on technology. Even in psychiatry, this is happening to some extent. But is that really an excuse?

My grandfather was a country doctor in a small town in Kentucky. I didn’t know him. He died before I was born. I grew up in the same small town. Many people told me how much my grandfather meant to them. He made house calls. He delivered babies at home. He saw his patients on their turf, not necessarily on his. I’m not saying that modern technology is bad, because the survival rate for babies and all patients is so much better now. But you can be sure that he knew his patients as people. He visited their homes, he saw them at their worst and at their best.  He treated their grandparents, parents, and children. There is something good about that. I don’t know how we can replicate that today.

When I wrote the required essay on my application for medical school, I remember writing that I thought medicine was the perfect bridge between science and art. We’ve tilted toward the science side, and that certainly has its benefits. We are saving more lives. We have a better understanding of why and how our treatments work. But I hope we don’t lose the art side of medicine.

So stand up for your personhood. Remind us, when we forget, that you are a person with a life above and beyond your diagnosis.  Remind yourselves that there is more to life than your illness, that you are members of a community, country, world and universe bigger than your illness.   Don’t get me wrong, I love the science of medicine.  We have made huge strides in the treatment of cancer, heart disease, mental illness and so many other diseases.  I love the black and whiteness of science. I love the certainty of science, though I sometimes wonder if that really exists. But I feel that we may have lost some creativity and humanity in the face of the explosion of technology.   When I end my career as a psychiatrist, I hope that I can say that I practiced the ART of medicine.

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