Helen Morant: How should doctors look at patients?

helen_morantWhen health professionals talk about patient engagement, we express ideas of listening to patients’ voices, understanding their priorities, and changing our treatment models and priorities to focus on theirs. We should treat (in both senses of the word) patients more like people and less like objects we control. We should stop dehumanising patients.

I was challenged to think about how we do just that as I listened to this podcast—it’s worth a listen all the way through.

It is an episode of Reply All, a podcast about the internet, which looks at the medical image app Figure 1. The app allows healthcare professionals to upload—and comment on—clinical images. The existence and popularity of the app raises a lot of questions. How should doctors behave on social media? Is the confidentiality issue covered enough? How do patients feel about doctors talking like this? Is the app educational? (Some of those issues are covered in more depth in this article on The Awl.

A lot of the podcast is about the difference in perception of these images by doctors and lay people. And one of the first questions the (generally squeamish and appalled) non-medic reporter asks is this: do I find these images more shocking because I am prevented from seeing them as part of a human being?

In medical publishing, and on this app, we use non-identifiable images. It is a legal requirement in the US and the UK, and an integral part of The BMJ’s policy of protecting patient confidentiality.

But there’s a question: by protecting patients’ confidentiality, do we dehumanise them?

If bits of a human are not identified as parts of a whole person, what effect does that have on how we perceive people and disease? Maybe the conditioning to see the disease and not the person starts and is perpetuated here.

In the podcast, Lauren (a resident who uses Figure 1) expresses surprise at the reporter saying the images are “some of the most horrific things he’s seen on the internet.”

“Most of it’s not Gawker [a popular gossip blog] worthy, but maybe I have lost more empathy than I thought.”

Lauren wonders whether being interested in the disease or the injury processes that caused a patient’s death might seem weird to people who see only tragedy. I know what she means. I often catch myself reading an obituary looking for the punchline . . . how did they die?

I don’t know whether it’s that particularly gruesome type of curiosity that made me want to be a doctor, or if it’s a way of thinking I’ve been trained into. In looking for the clinical facts, am I distracting myself from feeling human compassion? Perhaps it’s our education that conditions us to objectify patients, but maybe it’s instinctive self-preservation.

As Lauren says: “You can’t feel everyone’s pain as if it were your own or else you wouldn’t get through the day.”

I’m inclined to agree, but I don’t think that is necessarily what patients are asking professionals to do. And while this isn’t a review of ReplyAll (I’ve already given it five stars on iTunes), it is worth noting the voice that was missing—a patient.

Helen Morant is BMJ Learning’s clinical education specialist in North America, based in Washington, DC. 

Competing interests: No competing interests other than my employment by BMJ.