Abraar Karan considers the implications of healthcare systems that prime doctors to see people as patients
“It is much more important to know what sort of a patient has a disease than what sort of a disease a patient has.” William Osler, the “Father of Modern Medicine”
On a warm summer morning in the hospital, “Mr P” sat in the recliner chair in his room waiting for his medical team. Today was different, however. He was no longer wearing the usual orange hospital socks, or his teal hospital gown. Today, Mr P had laced up his dusty black sneakers. He had pulled his grey hooded sweatshirt on over a T shirt and regular blue jeans. When we arrived, he looked up at us (we were quite surprised—I personally wondered if he was planning to leave against medical advice) and announced, “I put my own shoes on today, and my jacket. It made me feel just a bit more . . . like me.” Who knew that such a small fix could make such a big difference in the way he felt—and yet, it should have been obvious.
This incident reminded me of a time last year when I saw one of my patients in the hospital elevator. She too was dressed in a T shirt, shorts, and sunglasses, and we both stood next to one another on the way down to the first floor. In this case, she had just been discharged so naturally she had changed out of her hospital attire. Nonetheless, I remember thinking how odd it was seeing her in “normal” clothes, without IVs in her arms, or EKG leads on her chest. Seeing her as just a regular person, walking out into the world like myself, was a confusing feeling. I think that this disorientated reaction is a symptom of a larger problem: what I see as the systematic dehumanisation of the patient.
As doctors, there are subconscious lenses through which we see patients, no matter how much we want to resist them. We inevitably become accustomed to seeing people when they are sick, in hospital gowns and beds, looking for help. With this, an unequal, highly nuanced power dynamic immediately develops. Mr P, whether he meant to or not, dismantled part of this, just by putting on his own clothes. We saw him differently—for myself, it reminded me that he was a person just like me: a man wearing sneakers and a hoodie, my usual outfit when I’m not in the hospital.
The mental shift that accompanies a job in which you are constantly seeing people who are unwell begins the moment one sets foot into the hospital. When I walk through the front doors, I feel a different weight of responsibility right away. I am no longer Abraar, I am “Dr Karan,” and if any clinical emergency happens, there is an expectation that I am ready to respond. This is not a bad thing—it is the reality of medicine; anything can happen at any time, so doctors need to be prepared. Thus, it isn’t surprising to me that doctors form mental frameworks through which a “person” is quickly transformed into a “patient.”
Thinking through this prism can be beneficial. It allows me to approach problems calmly and systematically, starting with a patient’s presenting chief complaint all the way to their final assessment and plan. This mindset of relating to patients has largely been the way “things are done” in medicine. Yet there is also something concerning about constantly seeing people as patients, because we then run the risk of forgetting that they are people first.
One example of this is in the way that we communicate both about and with patients. Ask any doctor, and they will probably admit that the way they “present” a patient’s case is completely different to how they would normally speak about someone in other contexts. Beyond overfocusing on symptoms (Mr K with pneumonia), we certainly underfocus on the personal details that we would normally give importance to when meeting someone new. Moreover, it’s easy for doctors to fall into the trap of speaking to patients in a somewhat scripted way. Perhaps this is because we often encounter similar clinical situations and when explaining medical concepts, we naturally develop a series of phrases that we reuse. Nonetheless, this can start to feel somewhat mechanical.
With all this in mind, I must ask: is there any benefit in dressing patients in a hospital gown? Why should we systematically remove the simple things that make people feel like themselves? Why should we dress Mr P, for example, in a monotonous robe that makes us see him as a patient rather than a person? Of course, there are pragmatic reasons for using hospital gowns: as a means of infection control, to provide ease of access for examinations or procedures, and arguably, they act as an equaliser so that patients are not judged based on what they’re wearing or how they look. Yet we should also think about the harm it may cause to remove yet another reminder of their individuality.
For most patients, I think that the sooner we can get them feeling like themselves, the better off they will be. This is about far more than just how they are dressed. This could also include making an effort to call patients by their first names if that’s how they prefer to be addressed; to ensure that we have a recent picture of them in their medical chart from before they were in the hospital (this has even been shown to reduce errors in medication orders); to make more efforts to understand their own stories (the Veterans Affairs hospitals in the US have started a programme in which students interview veterans on their life stories and include this as a note in their charts); and more.
I fear that we are operating in a healthcare system that primes us to see people as patients, when what we need is one that reminds us that patients are in fact people. As much as we try to make health systems more cost effective, of higher quality, and more accessible, we must do even more to make sure that they are humane, patient centered, and ones in which Mr P can feel a little bit more like himself.
Abraar Karan is an internal medicine resident at the Brigham and Women’s Hospital/ Harvard Medical School and is currently obtaining a diploma in tropical medicine at the London School of Hygiene & Tropical Medicine. Twitter @AbraarKaran
Competing interests: None declared.
The opinions expressed in this article are solely those of the author and do not reflect the views and opinions of Brigham and Women’s Hospital.