The Psychology of Care Giving
Does anyone tell med students that they will believe that their self-interest is virtuous no matter what the cost to patients?
More than a hundred years ago Mark Twain used to quip that quitting smoking wasn't hard. He had done it dozens of times himself. Audiences laughed.
Yet tobacco company executives late in the 20th Century testified before Congress that they did not believe that smoking was addictive or bad for people.
Scientific studies and surgeon generals' warnings aside, for at least a century the general public had known that it was addictive and unhealthy. Yet somehow tobacco executives with MBAs and decades of management experience didn't know and believed in that they were doing for a living was not bad for anyone.
One of the best ways to get people to believe in a thing is to get them to participate in it. Frequently, belief results from action even when the belief is not supported by reason, knowledge, experience or argument.
"Lack of sensitivity is perhaps basically an unawareness of
- Eric Hoffer
With the strength of the aculturation in medicine, they probably more are suspectible to this than most.
What behaviors in medicine are rewarded in ways that give health care professionals self-serving delusions like the ones held by tobacco executives? Does anyone teach medical students what those delusions will be and to be wary of them? Does anyone make medical students conscious of the powerful need caregivers have to believe in themselves as healers, and how that alone will cause them to filter information to support that belief?
The gap between truth and belief eventually is fatal
"If we had a keen vision and feeling of all ordinary human
life . . . we should die of that roar. . . "
- George Eliot in "Middlemarch"
People in college who major in acting often are required to increase their self-awareness by taking a course in the psychology of acting. In it they learn how their profession can distort their perspective. For instance when a paying job ends it is common for actors to believe that their careers are over and they never will work again. Speaking with other actors can support this belief because the other actors worry about it too. It is a common, but subjective and inaccurate, viewpoint. So in college they are taught to understand that they will think these this and why. They are taught that their perspective is subjective, that their feelings of despair during these periods are normal but not based on an objective assessment of the facts.
Is anything like that taught to medical students?
Things that once were obvious go off screen.
Does anyone teach students studying medicine how their professions will warp their perceptions? Does anyone tell them that the experience of being part of a group of people who have the same interests and fears commonly results in shared delusions being reinforced through repetition and agreement? Does anyone tell them how much of what caregivers believe to be concrete truth actually is just the self-interested delusions of their group?
Psychology courses for performers sometimes teach about the part of ourselves that, beginning in childhood, learns what behavior is rewarded and what is punished. That is a powerful influence on a person's thinking. Being personally rewarded is one of the primary sources of insensitivity about the costs of one's reward to others and a primary source of the rationalizations that mask or dismiss the moral problems and legal problems that might deny them the rewards.
Does anyone tell them that it is normal for healthcare professionals not only to be unaware of evidence that contradicts their worldview, but even to find ways to dismiss or deny that which they can't avoid discovering? Does anyone suggest to them what all this has to do with the hundreds thousand patients who die unnecessarily each year in medicine? Does anyone tell them how their subjective perspective will make it difficult for them to believe even that there are that many patients dying unnecessarilly each year?
Like imagining that what is good for physicians is good for patients, like liability limitations.
Does anyone explain to them that once they have prescribed a certain treatment for a patient, they will have a strong need to believe that they have done the right thing and to disbelieve that damage they caused could have been caused by them? Does anyone explain to them why they too will believe that the lawsuits and the complaints of patients are frivolous in spite of all the evidence to the contrary?
Does anyone show them court cases in which healthcare professionals distorted medical facts and/or lied under oath, and why they too someday man find themselves defending similar sins and/or crimes while believing it is the right thing to do, and what that says about integrity in medicine at every level? Does anyone show them examples of charts doctors have created of patients that entirely distort the patient's medical condition and the information the patient has reported and why someday med students themselves, if in similar circumstances, will be likely to do the same thing?
Does anyone explain to them how likely it is that at some point in their careers they will hide information, falsify documents, and, while doing that, believe that they are doing good?
Does anyone tell them that they, like all people, will trust members of their own group more than people outside their group, and how that makes health care professionals distrust honest patients while trusting healthcare workers whose self-interest, if recognized and understood, should have raised enough questions to reveal the lies and cover-ups in which the medical community willingly participates?
Does anyone explain to them the mental contortions that they will go through in order to maintain belief in themselves and protect their careers and protect their reputations and protect their colleagues, and how that will cause them to be in denial about problems that they, and their profession as a whole, cause for patients on a routine basis? Like the all the unnecessary deaths each year taken in stride with no one thinking the problem is with them or anyone they know.
Does anyone explain to them why they never will be able to see medicine through the eyes of patients and so never will see the perspective that could be regarded as the most important one? Does anyone even suggest to them that the perspective of patients might be the most important one? Where else in our consumer economy is it the perspective of the provider believed to be the most important one?
Does anyone tell them that when you are in the middle of something it is hard to see it? Since what we continually hear from health care professionals is that no one outside of it could understand it, it doesn't appear so.
There is no appreciation in medicine for the extent to which medicine is an imposing and overbearing industry that crushes patients when they complain. Does anyone explain to future healthcare professionals why they will never see themselves as crushing, blacklisting, and denying care to victims, but instead will see themselves only as protecting themselves and their colleagues from suits and complaints that they will imagine to be frivolous?
Caregivers have managed to conclude that patients are better off when caregivers are less accountable
". . . the quickest of us walk about well wadded with
- George Eliot in Middlemarch
Student drivers sometimes are shown films of what happens to drivers after accidents. Does anyone show medical students what happens to patients after getting injured in medicine?
What medicine benefits from not understanding about itself kills patients.