That was a rather provocative title wasn’t it?
I was marveling at the way some providers act in a contemptuous way towards their patients. You know; that patient who is a drunk, a drug addict, prostitute, or even a frequent flyer, etc.
In school many of us are told about paternalism as it relates to patient care. In the more modern world, it is commonly accepted that providers are not “above” a patient, but rather a partner, or as I like, a trusted friend and advisor.
So today I was trying to determine why providers judge their patients. Since I have some background in biological anthropology, I first decided to examine this issue as a matter of culture.
Culture is defined as: the ideas, customs, and social behavior of a particular people or society.
It occurred to me that medical providers usually have a different subculture than their patients, particularly along socio-economic lines. The lower the socio-economic class, the more medical help a person generally requires.
But this hypothesis proves to be a dead end. Providers don’t hate poor people. At least most of them don’t. Many providers also aspire to one day be a part of some medical mission to a less developed country in order to provide care. So the issue cannot be as simple as haves vs. have-nots.
I also noticed that this trend of contempt of patients is not unique to any country I have been to. It is a shared behavior. So I had to put my keen mind to the task and try and figure out what causes this…
Currently I am exploring the possibility it is a mating behavior. Perhaps these providers who always claimed to want to help people, a very common reason given for entering the medical or healthcare fields, are subconsciously seeing these undesirable patients simply as undesirable mating prospects? After all, who dreams of meeting the perfect alcoholic or addicted partner? The partner no matter what or how much you do for them simply continues to repeat the same destructive behavior or behavior of victimization? Why are providers so fascinated and eager to go half way around the world to help the “less fortunate,” but find these same people absolutely appalling when in their home range?
The most obvious answer is: they don’t intend to bring their “underserved” patients back with them. The provider can walk away from the environment of the unfortunate. Why can they not walk away from the unfortunate where they live?
The answer to this I think is 2 fold. For one, some providers are in a specialty or agency where their primary role is to help these people. The Emergency Medical Services as well as a number of hospital based medical specialties find this to be their primary population. I would ask “who didn’t know that going in?” After all, the respectable family man or mother of 2.5 kids in the middle class, in their socially productive prime doesn’t usually require any of these services or providers. The second reason I think goes back to mating behavior. In a primate’s home range, they have ample food, shelter, and reproductive prospects.
Providers, being primates, do not seem to want these “undesirable patients” in their home range. They do not take their food or shelter from them. They do compete for mating prospects. In fact, many providers go as far as to punish, humiliate, not properly care for, or otherwise attempt to drive these patients away. A person certainly wouldn’t do that to somebody they wanted in their mating pool.
In a round-about way, this might be attributable to the lack of paternalism in modern medicine. The position of authority and social status as being “above” undesirable patients creates a separation in the reproductive pool. They are not in your mating pool, because you are clearly acknowledged as superior. You act it and they reciprocate this hierarchy. The modern concept of the patient as a friend puts them on an equal plane. They are for all intents and purposes the same as you. It can even be taken further by the concept of treating a patient as a customer. You are there to serve their demands. Now from a social standpoint you are not just equal, but inferior!
The British providers I know derogatorily refer to patients as “punters” which is their word for a person who hires prostitutes. In American parlance, if your patient is a John, what does that make you? It takes the idea and value of “patient satisfaction” to a completely different level. Should your patient satisfaction survey reflect poorly on you, it is likely you will be slapped around a little by your pimp (employer) until you start to “properly respect the wishes of your customers.”
There are several consequences to this. First, it leads to over or improper treatment for customer service. This increases medical costs. It may even play a part (this is a controversy not a fact) in problems like antibiotic resistance. It certainly degrades providers, which in turn leads to the behaviors of punishing or failing to properly care for the patients by mechanisms such as withholding treatment.
But this goes back to the issue of mating behavior as well. Most prostitutes do not see their John’s as partners they want to reproduce or have a relationship with, though they may pretend to and go through the motions. Just like modern healthcare providers and “undesirable patients.” They are simply not wanted in the mating pool.
Clearly something must be done for the benefit of the providers and the patients. But what?