In his book Why We Revolt (Mayo Clinic Press, 2020), Dr. Victor Montori writes about cruelty in health care. In this excerpt from the book, he describes the unintended effects of heavy patient loads on both patients and health care providers.
Cruel policies affect how our work is done. Impossibly busy appointment schedules and heavy patient loads force clinicians, even the kindest, to see patients as a blur, noticing nothing particular about any of them. Policies that place vast distance between the administration and the hospital ward, between the receptionist and the bedside, between the decision-maker and the petitioner. This is a distance from which Ana, Jose, and Susan cannot be distinguished from one another or from other patients, each one reduced to a faceless “them.”
These policies, motivated by the same industrial justifications, often dehumanize not only the patients but also those who are supposed to serve them and help them heal, even the kindest. The dehumanization of clinicians makes them expendable and interchangeable, like light bulbs. Light bulbs that, as the cruel system is finding out, can also burn out. And burned-out clinicians and staff manifest a key deficit: the inability to respond to the suffering of a fellow human with empathy. Cruelty incites cruelty.
And yet even amid incidents of cruelty, we find accidents of care. A nurse stayed after her shift to help her elderly hospital patient use his laptop to witness via live video his granddaughter’s graduation. On her way home, a pharmacist took the box of medicines for a sick child traveling in Germany to the main office of the courier company after the prescription missed the courier’s last pickup. Five days after operating on his patient’s hip, the surgeon brought a chair he had at home to the patient’s hotel room to make it easier for him to take a shower. Humans recognizing each other as fellow humans, confounding what others expect of them, overcoming fear and violating the care protocols to make room for care, eschewing reputation in favor of a moment of intimacy that no one may even notice.
The antidote to cruelty is in the humanity of clinicians who, in a moment, remember why they went into health care. It is in rejecting the tendency of industrial health care to cause cruelty and to make each one of us capable of realizing our infinite potential to be cruel to others. It is in policies that make noticing each other the easiest thing to do. It is in creating space and opportunity for us to realize our equally infinite human potential to care for and about each other.
Watch this animated video about cruelty in health care from Dr. Montori’s nonprofit organization, The Patient Revolution.
Victor Montori, M.D.
Dr. Montori is a physician and researcher at Mayo Clinic in Rochester, Minnesota participating in the care of people with diabetes. Considered “a patient’s doctor,” Dr. Montori received the Karis Award, a patient-nominated recognition for his compassionate care. His research in the science of patient-centered care has made him one of the most cited clinical researchers in the world. In 2016, Dr. Montori founded The Patient Revolution, a nonprofit organization dedicated to advancing careful and kind patient care for all.