Assembly Line Medicine
A doctor describes her own experience with efficient mammography in Health Affairs:
Although I’m in the “most woman-centered” mammography place in town, I’m left with the feeling that I’d been through a “breast mill,” passed among many staff members performing single tasks as they send me through their assembly line.
Certainly this center excels at having staff members who function at the top of their skill set. The physicians here have only the amount of patient contact required, with the nonmedical staff handling every other detail. Presumably this results in high efficiency …. My experience of being efficiently run through this breast mill, however, reveals the lack of a needed additional feature: care that centers on the patient…. As soon as my routine screening experience headed south, I craved a human connection. I resorted to an illicit phone call to my husband to have a person care for me.
I longed to have someone at this practice accompany me through what was going to happen to me next… In part because of the practice’s great efficiency, my experience with the repeat imaging and biopsy left me feeling alone and like a dehumanized number.
How unfortunate that Dr, Fogarty is not entirely happy with the efficient delivery model of mammography she has experienced. Is the reason for the displeasure based upon the failure of the model to deliver what she needed or failure to deliver what she wanted? It is a distinction which cuts to the very heart of the health care debate.
While Dr. Fogarty’s description of her discomfort is compelling and connects with most readers who might be placed in similar circumstances, the reality is she was not the victim of a failure to address her needs, only personal wants. Unfortunately, human wants are essentially infinite. In other domains, individual human wants are catered to by market approaches which are contingent upon those receiving the services being willing and able to use their individual resources to entice other parties to fulfill their specific wants.
It should not be viewed as surprising that when market approaches are systematically excluded from delivery systems that one of the first casualties is the ability to address human wants. Later as mis-allocation of resources also impacts the human needs piece.
I agree totally with the medicalcontrarian.
Assembly line medicine. Cook book medicine. Is there a difference?
People who object to impersonal medicine haven’t seen anything yet.