Is it possible to have too much care?
Apparently, a lot of primary care docs in this country think so. In a study published in Monday’s Archives of Internal Medicine, 42% of primary care doctors surveyed said that their patients were receiving too much medical care, and 28% said “they themselves were practicing more aggressively (ie, ordering more tests and referrals) than they would ideally like to be.”
But is it really possible to have too much care?
Well, it depends on how we define our terms.
If by care we mean what we usually mean by the word — sitting with someone, showing concern and empathy, listening, attending to their needs — then no, I don’t think we can have too much care.
But if we replace this humanistic definition of care with a technical definition of care, as in, “I show care by ordering something for this patient, whether it’s a test, a procedure, a pill,” then yes, we can have too much care.
Because every pill or procedure has side effects; every test carries its inherent risks. And all of these interventions cost money, and add cost to a system in which the medical costs are skyrocketing at unsustainable levels.
Interestingly, the doctors in the study gave “Inadequate time to spend with patients” as one of the top three reasons they provide too much technological care. The humanistic type of care requires time. In a system that pushes doctors to do more and more, there is less and less time to care for patients. So the time taken to provide humanistic care is replaced by techno-care: tests, studies, etc.
There are many patients who are truly underserved, who get neither enough humanistic care — time with a doctor who knows them — nor enough technological care — that is, appropriate tests and interventions. But we will never have the wherewithal to serve these patients unless we stop pouring money into inappropriate technological “care” that serves as a poor substitute for the humanistic care we can’t seem to take the time to provide.
An e-mail went around our office asking the docs what were the top three things patients came to see them for. One experienced doctor wrote, “I decided the top three are love, attention, and sympathy.”
Those things, the essence of real care, require real time. How do we change a system so that it stops encouraging the provision of expensive technological care as a replacement for time-consuming humanistic care?
As a society we need to find an answer, or we will not be able to afford either one.