Medical ethicists have made amazing contributions to health care.

They’re heroic in their fearless pursuit of better care for beings – especially the human ones. They seem never to forget that is what they do. They work on the edges of what we know and are usually ahead of what we believe. They poke and prod us to do better. God bless ‘em.

Bob Veatch – one of my very favorites – has written a brilliant new book¹ on the subject and I recommend it highly. It is a product of decades of deep thinking; he’s produced yet another gem.

Unfortunately, the title does not reflect the depth of his thinking; it’s far shallower than that.

The text pushes the edges of what we know and is ahead of what we can produce in health care today, but the title pushes it over the edge. I suspect some editor or publisher picked it. The Bob I read, have heard speak and have once met is better than that.

I recommend it as required reading for anyone – legislator, regulator, staff, advocate, clinician, institution, payer or reporter – involved in health reform. It is brilliant, thoughtfully constructed and engagingly-read.

So, why do I dislike the title? For two reasons:

First, I don’t see Bob arguing that the patient heals themselves – or even can. Rather, I hear him addressing the myriad of uncertainties that accompany any clinician-patient interaction, the complexity of the health care system we have produced and the lack of any one, clear culprit in the mess we face today. It is full of cautionary tales for those who think another set of regulations, EMRs and financial incentives will “fix” it all.

Second, my review of the history of healing says that no culture has ever believed that patients are healed ‘on their own.’ My read of today’s health care crisis agrees.

Healing, one of the two gifts from the divine in every culture we know about (the law² being the other), proceeded as a gift from ‘a more powerful one’ to the individual in need. That powerful one was initially – and in views of many remains today – the divinity of the patient’s choice. Clinicians, as healers, were aligned with that force, for the good of the patient and the community. That alignment created medical oaths and held them to high standards.

Sure, we’re more scientific today and some us even believe that illness is divine retribution³ , but just knowing how a virus replicates in our bodies or where a cancer s metastasizing is insufficient comfort. If we’re sick, we want help. As Bob points out, patients have different, highly important views about what will help will work and be best for them. They may see it in prayer, in medicines, in exercise or even in reframing their definition of health (and beauty!).

Compelling evidence of what the patient needs can be seen elsewhere in this blogspace. Phyllis Kritek⁴, like so many other clinicians before her, needed healers:

• A healer to be welcoming upon arrival. This was her first visit to an unfamiliar facility and yes, the receptionist is a healer. This facility can take note of the reception desk of one client I visit. The name plate reads “Director of First Impressions.” That facility should read that and weep at the impression it created in that first encounter.
• A healer to usher her to change,
• A healer to explain the consent form, research project,
• A healer to see explain the contrast media,
• A healer to see her as a person that ethicists so vigorously ask them to address – as a human person as she received care.

As a clinician, Phyllis had the presence of mind to cope better than most. Like a clinician, trained in and ascribing to ethical standards, she should have been treated and she articulates anger that is unfortunately the norm in health care today. In her dependent (she needed the tests) and vulnerable (near naked) state, she nonetheless was able to capture, record, process and report her experience. God bless ‘er.

It leaves me wondering about solutions to the plight she describes.

• Perhaps the Ritz Carlton should take over the all-but-clinical operations of facilities.
• Perhaps, as Jennifer McCabe⁵ describes in this blogspace, we all need to show up with an advocate to assure we really get care.
• Perhaps the National Health Council should get more airtime to address their health reform proposals, which are directed to addressing the patient-centric issues Bob Veatch pokes us to think about.

You tell me….but to do so, you’ll have to read Bob’s book first – the best, most thoughtful, sobering set of cautionary tales about health reform, told by a very wise man.

Required reading. For everyone. Especially those engaged in reforming the care we’ll get.
References
1. Veatch, Robert, Patient, Heal Thyself, Oxford University Press, Oxford, 2009.
2. For an examination of the law as gift, see Alan M. Dershowitz, The Genesis of Justice, Warner Books, New York, 2000.
3. Raman, L., and Winer, G, “ Evidence of Immanent Justice Reasoning in Adults,” paper presented at the 107th Annual American Psychological Association Meeting, Boston, 1999.
4. http://www.disruptivewomen.net/2009/05/26/health-care-or-product-management/
5. http://www.disruptivewomen.net/2009/05/11/thoughts-on-being-a-patient-advocate-how-to-compose-a-patient-advocate-agreement/

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