February 2023 Communication Tip
Personhood
Last week, Harvey Max Chochinov (a distinguished professor of psychiatry at the University of Manitoba and author of “Dignity in Care: The Human Side of Medicine”) published a short opinion piece in a Canadian paper about personhood, "Why is being a patient such a difficult pill to swallow?"
The idea is that patients (full-fledged, unique humans with dignity) lose some of their personhood when they enter the medical system as they often are treated only as generic manifestations of common pathophysiology and illness.
Chochinov writes: “Who you are as a person is highly unique; never has there been, nor will there ever be one exactly like you. Being a patient, on the other hand, is based entirely on things that are generic. With all due respect, whether prince(cess) or pauper, poet or pilot, your bits and bobs are pretty much identical, in form and function, relative to everyone else’s.”
Yes… we all have pretty much the same bits and bobs. A 62 year old woman with a long, detailed, and glorified history as a singular person all too easily can become simply the patient with de novo metastatic breast cancer coming in for Day 1 of Cycle 2. But, unquestionably, she is both. She is coming in for her 3 pm appointment to get standard of care treatment AND she is not just “my 3 o’clock.”
To honor the unique personhood of each of our patients, Chochinov recommends asking the “Patient Dignity Question”-- “What do I need to know about you as a person to take the best care of you possible?” Here, we can ask central questions that matter to the particular care and goals of this particular person. “What matters most to you?” “What do you hope for?” “What worries you?”
And, of course, the individual dignity of our patients is not all the matters.
We matter too.
We as health care workers are not just filling generic roles with routine, discipline-specific clinical competencies. You are not just the doc in the box, the Apex RN of the day, the on-call fellow, the attending on-service, Medical Student 3, or Practice Coordinator 2.
Who you are matters as much as what you know and what you do. You are you (unique, with dignity) AND we each fill a role in a large system. Both are true. Both are important. It is both/and.
People with illness deserve evidence-based, sometimes guideline-driven treatment AND the details of who they are matter. Do your health care job well AND remember too that you (in particular) matter.
All My Best,
Mike
P.S. You can find an archive of past communication tips on the MERI website: https://meri.ucsf.edu/meri-center-communication-tips.