Care: We work with people, not illnesses

Let’s hop in a time machine and go back 90+ years to 1927. To set the context, Calvin Coolidge is president. The world is getting smaller as the first transatlantic telephone call is made between NYC and London and Charles Lindbergh makes the first transatlantic flight between New York and Paris.  Back in Boston, Francis Peabody is addressing students at Harvard Medical School on the topic of the “Care of the Patient”.  He says:

"...young graduates have been taught a great deal about the mechanism of disease, but very little about the practice of medicine – or, to put it more bluntly, they are too “scientific” and do not know how to take care of patients".

He goes on to ask:

"Can the practitioner’s art be grafted on the main trunk of the fundamental sciences in such a way that there shall arise a symmetrical growth, like an expanding tree...?"

Peabody then reminds us that:

"...The treatment of disease may be entirely impersonal; the care of a patient must be completely personal. The significance of the intimate personal relationship between practitioner and patient cannot be too strongly emphasized, for in an extraordinarily large number of cases both diagnosis and treatment are directly dependent on it, and the failure of the practitioner to establish this relationship accounts for much of the ineffectiveness in the care of patients..."

These words from 1927 echo across time and ring true today.  Evidence-based practices can be executed with high fidelity by teams of highly skilled clinicians. But if these clinicians are treating diseases, then the work is impersonal and can obscure the humanity and wound the dignity of the people being served. When the work is impersonal, it dehumanizes people and this is a type of violence.  It is what I call toxic help or help that hurts in the long run.

Care, on the other hand, is deeply personal because it occurs between human beings.  Care requires relationship.  The phrase “Systems of Care” is an oxymoron. Care is delivered, not through systems but through relationships. As Francis Peabody famously said, “...the secret to the care of the patient, is caring for the patient.”  I would paraphrase and say the secret to the care of the patient is caring for the person.