Hospitals should work to become cathedrals of care, says Victor Montori
“The desire to see things as they are, to find out true facts and store them up for the use of posterity,” that is the reason one must write, George Orwell said. It’s the reason Victor Montori, a professor of medicine at Mayo Clinic, wrote this book.
Through a series of personal essays, the author explores the inherent cruelty of industrialised healthcare and how it has dehumanised the patient.
Modern healthcare, which offers the benefits of expert surgical teams, clean and efficient facilities and the latest equipment, still manages to reduce the patient in the mind of the doctor to a mere file filled with results of tests and procedures, lists of medication and sometimes-conflicting notes from other specialists.
Montori talks to people from within the healthcare industry as well as to patients about whether they too feel that this is now a system where care is accidental and cruelty incidental.
Instead, he asks, could we not work towards a system where a hospital more closely resembles a “cathedral of care” where patients receive treatment that makes emotional, intellectual and practical sense to them and their worldview?
In the introduction, Montori offers the disclaimer that, “as an academic, I have endeavoured to be rigorous and reasonable. But this volume is not dispassionate, impartial or academic. This is a soulful download, an honest account”.
The book begins by talking of the cruelty of petty rules that makes doctors redraw a blood sample from a patient because it reached the investigation counter after the deadline. The callousness of regulations that make a woman miss her medication because she called in a day too early and the pharmacist could not process her request for a refill. The cruelty of doctors colluding with pharmaceutical companies and promoting recently approved drugs to the people of a developing country like India.
Montori describes his experiences with the overworked and overwhelmed junior doctors working at a premier teaching hospital in Lima, Peru.
He was just one year away from graduating. The emergency room had a queue of patients waiting outside; the ones inside lay on gurneys, slouched in chairs, sat on the ground in the hallways. It’s an image not unfamiliar to anyone who has been to a government-run hospital in India, or indeed to our own premier teaching hospital – the All India Institute of Medical Sciences in Delhi.
Montori goes on to show how a slight miscalculation on the part of a doctor about whether a patient would need local anaesthesia while during the cleaning of a laceration, led to a scuffle between the patient and the doctors. Again, a regular occurrence at our government hospitals.
It is time, Montori argues, to change the way care is administered within our communities; time to transform healthcare from an industry to a service.