Thursday, June 14, 2012
Disease-ification: How a person becomes a pathology
"Every patient is the only patient."- Arthur Berarducci
"Each person in need brings to us a unique set of qualities that require unique responses." -Don Berwick, Escape Fire 1999
To generalize and then classify a unique person's health complaint in order to match them with an effective remedy that ends to encounter; often done out of convenience, expedience, or for profit.
Unique is a funny word. Every time I come across it, I am reminded of my high school English teacher's admonition that qualifying the word--very unique, kind of unique--is inappropriate. Things are either unique, one of a kind, or not.
Although Dr. Berwick did not have my English teacher, I think he would agree that each patient's presentation is unique in this sense; it is one of a kind. Even the most mundane complaint is buried in a rich social and genetic context that simply cannot be reduced to a chief complaint.
As a moral enterprise, medicine seeks to serve patient interests, and few interests supersede the need to be treated as the unique identities that we are. Therefore, to disease-ify must be seen for what it is: a capacity to cause harm in a profession that professes to do none.
Disease-ification is an important cause of the well-documented harms of overtreatment. In order to serve his or her role in each patient encounter, the assumption is that a physician needs to identify a disease and then match it with a remedy. To do otherwise is to dither.
To Practice Medicine Verb
To generalize and classify a unique person's health complaint in order to match them with an effective remedy, all the while acknowledging and preserving their uniqueness, in order to heal.
In his inspirational 1999 speech Escape Fire, Dr. Berwick states that "we are not finished--we have not achieved excellence--until each individual is well served according to his or her needs, not ours." Interaction with patients is not "the price of care; it is care, itself." A patient's question is "an opportunity, not a burden."
As I begin my internship next week, I hope to live up to Dr. Berwick's aspirations, to learn how to practice medicine, and resist the urge to just disease-ify.