The nurse who was taking my blood sample asked me: are you afraid of needles? I had to smile. All my childhood was spent with doctors and nurses. I grew up in a hospital. For thirteen years, my social life consisted of doctors and nurses, and fellow patients. For sure I had a longer and more extensive experience of needles than the nurse who was asking me – for me, nothing could be more normal, in a way reassuring, than the process of taking a blood sample.
I tried to explain this to the nurse, to point out that the people she met were all different individuals, all with our own personal story, that being “a patient” did not mean that we would all have the same needs or feelings in this situation. I tried to talk with her as one human being with another, telling her about myself, trying to learn about her thoughts, but she was obviously ill at ease.
On my way home, I started to think about the short conversation I had just had. I realised that something similar happens a lot in my contacts with the health care system. Whenever I meet a person, in whatever situation, I approach them as a human being. I am interested in their story, try to imagine their experiences and feelings, aware that each person is unique. For me, each meeting is an opportunity to get richer, learn something new, enjoy this short space of time that we have together. But in the health care system especially, I face another kind of expectation. Doctors and nurses who are ploughing through their daily routine, heads down, bracing themselves to deal with another batch of “patients”. On the assembly line of health care, each meeting should follow a predetermined script of standard questions and answers. Each person who enters the door of a hospital or primary care centre is expected to step into the role of the “patient”, leaving their personhood outside.
In their training, doctors, nurses, physical therapists, or occupational therapists learn to act “professionally”. This means, on the one hand, to detach themselves completely from their own personhood, all their feelings or fears in the situation. On the other, it means that they are drilled to no longer see the person in front of them as a human being. This is much like the training that the military goes through, and which allows them to do to other human beings what no human ever should. The similarity is probably no coincidence, the modern professions of surgeon and nurse developed historically in military contexts, notably the Crimean war.
In any other context, this kind of detachment would be understood as a dissociative disorder. In the context of health care, it is understood as a necessary stance, to bear a situation that would otherwise be unbearable and to act in ways that would otherwise be unthinkable. After all, how else can you cope with seeing human suffering on a daily basis, without getting engaged, without mirroring yourself in the other person?
The health profession I have had the most contact with are physical therapists and occupational therapists. A few years ago, I met an occupational therapist, Karin, who was one of the sweetest people I have met in my life. I really wanted to be her friend. But because we were locked into the “professional” roles of the situation, and because of the rules and regulations, neither of us was able to start a friendship from this appointment. So, one day I joked with her and said, Karin, we are meant to be friends, and she agreed, saying I really need a friend like you. I said, don’t worry, one day you will retire, and you won’t have this professional contact with me, and then we can have two beers, sit beside the sea and talk about the problems we couldn’t talk about today.
The professional stance is rationalised as a way to avoid burnout. It is also seen as a way to avoid discrimination since the treatment a patient receives should not depend on personal feelings or prejudice. At the same time, by this stance, the professionals of the health care system deprive themselves of the energy and joy of human contact. Meeting other human beings, both in happy circumstances and in difficult times, is deeply rewarding. Implicitly, framing contact with humans who are suffering as something to be avoided, is also denying that life consists of happiness and grief intertwined, you cannot live without also experiencing pain. Can you really be a good doctor or nurse if you are in denial of the suffering that is at the core of your profession and if you deprive yourself of the possibility of empathising and trying to understand what the individual in front of you is experiencing?
Following a predetermined script may save time and be intended so as not to miss a point on a checklist, but routinely working your way through such scripts also prevents health professionals from listening and being attentive to what the person in front of them is actually saying. In my role as a patient, I seldom see that doctors or nurses hear what I say, or take it into account, leading to repeated misunderstanding and miscommunication.
Spending long hours daily detached from your humanity wears health professionals down, places them in a state of constant numbness. And despite the rational arguments for a “professional” stance, health professionals do burn out. Contact with a dehumanised and depersonalised health care system also wears patients down. Being reduced to the role of an anonymous “patient” is dehumanising, and leaves an unsettling sense of having been abused, even if the words you hear are pronounced in a measured pleasant tone. And how will I be understood if I am expected to be acting as a “patient”, following the script? Will the doctor write in your journal that you are being “emotional” if you express the pain that you are feeling?
If you only have brief contact with this system, it may be easy to brush off the sensation of dehumanization. For people with disability, for people with serious conditions that require intensive treatment, for those with chronic conditions or the elderly who accumulate an increasing number of minor or major health issues, contacts with the health system are frequent, and - just as for the people who work within the system - it affects our sense of self. For many, like during my own childhood, contacts with professionals in the health care system may be the only social contacts they have. Now, during the pandemic, this has become even more acute. Due to social distancing, I personally rarely meet any people in real life except health care professionals. For many of those hospitalised for Corona, contact with health care professionals will be the last contact they have in their life.
Despite the various rational arguments put forward for the “professional” stance, I believe that other stances are possible. In my life, I have met doctors and nurses who accepted that I was human, just as they were humans, and who loved their work for the opportunities of meetings that it offered. These were the meetings that gave me strength and made me feel better, regardless of whatever disease or condition I had consulted them for. There is another way, but it involves bravery, vulnerability, and accepting the complicated mixture of pain and joy that life offers.
Chavia Ali