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Dehumanization
of Contemporary Medicine:
Causes and Remedies
by Marek Pawlikowski
Institute of Endocrinology, Medical University of Lodz, 91-425
Lodz, Sterling Str.3, Poland.
Correspondence to:
Prof. Dr. Marek Pawlikowski,
Institute of Endocrinology, Medical University of Lodz,
Sterling Str 3, 91-425 Lodz, Poland.
TEL +48 42 636 54 27 FAX +42 632 48 54
E-MAIL: m.pawlikowski@mail.e.pl
Patients, as well as physicians, agree that contemporary medicine
has undergone aprocess of "dehumanization". My intention
is neither to define this phenomenon nor to illustrate it through
examples taken from medical praxis. I would like only to indicate
some of its probable causes and to propose some possible counteraction.
The
causes of the "dehumanization" of medicine can be
divided into two categories: intrinsic and external. The intrinsic
causes are specific to health care and, to some extent are the
"side effects" of its progress. I will list them in
a rather hazardous order, not necessarily connected with the
hierarchy of their importance.
First,
the mode of the reductionistic thinking should be mentioned.
Contemporary medicine is based on the natural sciences, and
in the natural sciences the reductionistic approach is not only
very popular but very fruitful as well. This approach consists
in the reduction of the studied phenomena to its most elementary
level. Thus, psychological phenomena are reduced to the biological
level, and the biological processes to chemistry and physics.
A good historical example of such "reductionistic"
tendency in medicine could be the cellular pathology of Rudolf
Virchow, its contemporary equivalent is certainly molecular
biology and pathology. At the present time, a similar tendency
is connected with the molecular biology and pathology.
Another
intellectual approach in science is the "isolation"
of systems, organs or cells in order to reduce the level of
complexity of the examined problems. In fact, this approach
is not solely intellectual: experiments in vitro offer a good
example. On the other hand, it should be underlined that the
above mentioned "reductionistic" approaches are often
very fruitful in resolving scientific problems and cannot be
rejected, at least at the stage of research. In contemporary
biomedical science, we can observe also the opposite tendency.
For instance, the development of such new interdisciplinary
domains as (psycho) neuroimmunoendocrinology, certainly
supports an holistic mode of thinking.
However,
till the present time, the "reductionistic" attitude
has been prevalent. Such an attitude, deeply rooted in the minds
of lecturers, is transmitted - even involuntarily - to medicine
students. In consequence, the students, in their future professional
activity, may have been inclined to perceive a patient not as
a person, even not as a whole organism, but as an "ill
organ" or "bad genes". The patient is perceived
exclusively in scientific terms. That leads to treatment not
of ill subjects, but their ill organs, and even of deviations
from normal values in laboratory investigations.
It
seems necessary to indicate also another feature of modern science,
namely, the lack of axiologic reflection. Science does not evaluate
described phenomena in categories of good and wrong. On the
other hand, in medical practice ethical values have been present
since Hippocrates and medicine is based on the assumption, that
health is good and disease is bad.
It
is also quite obvious that progress in medicine is in a great
part secondary to progress in technology. Paradoxically, engineers
have contributed more to the progress of contemporary medicine
than physicians and biologists. This substantially positive
phenomenon has its "reverse" side: it also contributes
to the "dehumanization" of contemporary medicine.
New, sophisticated diagnostic procedures separate patients from
their doctors. Patients become synonymous with the machine;
almost anonymous to some members of the medical team who play
a very important role in the process of diagnosis, e.g. to radiologist
or pathologist. Consequently, medical staff also remain practically
anonymous to the patient.
Progress
in technology and biotechnology open new, previously unexpected
therapeutic possibilities, but raises also new ethical problems.
Let me quote here the words of Pope John Paul II, that: not
all which is technically possible, is at the same time ethically
acceptable.
Another
factor influencing the "dehumanization " of medicine
is "hyper-specialization". This latter is a
simple consequence of the enormous enlargement of knowledge
which clearly surpasses the intellectual abilities of a single
person. Hyper-specialization has two unfavorable consequences.
Firstly, it impacts segmented perceptions of a patient’s
organism and personality. Secondly, it creates a situation in
which the patient is cured not by a single doctor, but, quite
usually, by an uncoordinated or badly coordinated team. However,
specialization in medicine seems inevitable and irreversible;
nostalgic dreams of the re-emergence of the omniscient doctor
are rather Utopian. We cannot retreat from specialization without
a drastic limitation of the knowledge and ability of physicians,
and, in consequence, without a limitation of opportunities for
our patients to be well diagnosed and well treated.
However,
the above mentioned and shortly to be discussed "internal"
causes of the dehumanization of contemporary medicine, closely
connected with its development, are not the sole factors responsible
for this crisis. There are also numerous "external"
factors which play significant roles. Medicine has always been
a part of civilization, and undergoes the same global crises
which touch civilization as a whole. The limits of this short
text and perhaps also the limited competence of the author do
not allow a deeper discussion of these problems. In spite of
different views of many particular problems, numerous contemporary
authorities, including Pope John Paul II and philosopher Karl
Popper, perceive the sources of this crisis of contemporary
civilization in ethical and cognitive relativism and in consumerism.
The
Latin maxim says: Qui bene diagnoscit bene curat. But
even if the diagnosis of "dehumanization" of medicine
presented above is proper, the search for apropriate remedies
may be very difficult. At least two postulates, however, can
be suggested.
The
first is the radical change of the model of health care.
The main role in the new model should be played by a family
doctor, who should be a personal advisor to the patient
in his/her health problems and a coordinator of the team
of specialists if the patient needs specialist care. However,
it has to be emphasized that the family doctor should not be
a substitute for specialists. Any change of a health care model
needs a re-orientation of undergraduate medical education, in
terms of greater attention paid to problems important in general
praxis in deference to more specialist studies which should
be transferred to postgraduate education. However, this re-orientation
should not be realized at the cost of the basic and pre-clinical
disciplines which are absolutely necessary for understanding
health and disease.
The
second postulate is the humanization of medical education.
This could be achieved by the larger inclusion of such disciplines
as ethics, history, philosophy and sociology of medicine in
medical education. I would like to indicate another interesting
project realized at some universities, i.e. the inclusion of
analyses of literary texts dealing with health problems into
the medical curriculum. Obviously, the lecture of belles-lettres
rather cannot enlarge the professional knowledge of the medical
student but it can facilitate him/her to understand what the
patient’s and their relatives feel, what they might expect
and are perhaps anxious about. The steps proposed above, in
themselves, certainly are not sufficient to effectively counteract
the dehumanization of medicine. However, the most important
appeal, is to realize that although medicine cannot and should
not resign from its scientific foundations, it must not approach
the patient scientifically only.
Received: January 8, 2002
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