Humanism in the time of metrics—an essay by David Loxterkamp

From through the leaves of the acacias there radiates a drone of propeller sound. The de Havilland flies low over a scrub which is barbed with the thin-barked trees. A man stirs to the sound. Around him the recession of the night has been replaced by a daubing of the African sky with first light. He sits alone by a desolate field in the weight of the morning. His field has threadbared into a welter of sunburnt grass and entropies of scrawny flower. Momentarily, his face is quickened by the metal bird which silhouettes into the dawn, as he hears the insistence of its burring motors over the calm of a millennium. Sight dimmed by cataracts, starved of light, the man has survived because of his indomitable woman. Out in the hinterlands of Africa, his continuance will be through his children, and in them the circle of life has already begun swerving its first arc. His smooths the earth with his hand and, through the velvet of blindness, sees the scrub which wreaths over a soil once emblazoned with spears of lush maize. The farmer wants to work his land again. He has been waiting for this plane. The eye surgeons have arrived. He will work his land again.

Without the accoutrements of a developed country, the visiting team will perform surgery to restore sight, and the gratitude of a host surgeon will remain vivid through correspondence filtering across a concertina of years. The surgeons will know their patients only by the smallest of measures, but their satisfaction from the care will be of the largest measure. Without any fluencies of dialogue between patients and surgeons, “goodwill and gratitude” will miraculously recipe into the utmost humanism. Expressed to its greatest degrees is humanism in a rural Africa which is bereft of clever systems or technology. The timorous faces of African patients contrast with the expressions of malevolence observed by a tired surgeon as he catches the bus home on his return to the developed world. Economically privileged areas can seem the most dehumanised and spiritually derelict locations of the world.

As a family physician, Dr Loxterkamp from America considers the threat to humanistic care when the time of doctors is largely spent rectifying numerical indices, as obeisance to national frameworks for population health. My colleague cites the box-filling by which he is enslaved when his patients are riddled with prosaic predicaments, such as marital discord, and for which they most require his support in the confines of a consultation. He mentions serum cholesterol as one index amongst the staples of family medicine which monopolise his limited energies. Of special poignancy is his remark that today a doctor may converse with a computer in place of detecting useful revelations on the face of a patient. My colleague verbalises his feeling of dehumanisation in the unfathomably complex technoscapes of contemporary medicine.

The clinical workplace which sinks Dr Loxterkamp into a fugue of dejection is itself emblematic of the society fermented over the last twenty years. Retrospectives on this time will show that this was a tempestuous nexus of change. Bewilderments of the present are sometimes better tolerated when juxtaposed against the yardstick of history : only years after the Wright brothers made frog-leaps on the flimsiest of flying contraptions there arose aerobatic machines which could fly armoured with repeating-guns into the commotions of the First World War. Those politico-technological developments over only a dozen years comprised a historical pattern of astounding amplitude.

Patterns from the recent course of history have similarly intensified over the last twenty years especially in the richest areas of the world. The first tides of population longevity have beaten forcibly against the walls of besieged health services. Coupled to these demographics and the advances in medicine, the superimposition of a digital revolution has redesigned the experience of being a human being -----and thus the functioning of society en masse. Money is apportioned by walled computers and in the supermarket the customer can enter aisles where another computer is found silently perched at the till. Technology has superficially brought connection, but ironically a deeper fragmentation of society, and a peculiar alienation of the individual within the articulacy of talking electrons.

Against these wider sociotechnical trends, “the potential for dehumanisation” is noteworthy within health systems, which necessarily must run under high levels of organisation. Systemisation, for instance, allows patients to attend a busy list so that the same drug is given to each person at the same dose. “Efficiency, efficiency, efficiency” is the slogan of such prideworthy services which engender sustainability in healthcare. However, though treatment can be systematised as a technical procedure, the reaction of a patient to the clinical episode cannot be standardised. Humanistic care for a patient is a dynamic response from the clinician which meets the individual reactions of a patient. Considerateness cannot be measured, electronically boxed, and tariffed by the spinning cogs of healthcare scrutiny and economics. Over the accelerating last decade, this point has underpinned the remonstrance of clinicians within the politically-charged arena of healthcare economics. Under the asphyxiations of intensified healthcare, my colleague from across the Atlantic asks for a concerted preservation of humanism in medicine. His exhortations make sense : experience shows us that humanism is resoundingly what patients most want from their doctors.

We must all better appreciate the dehumanising capacity of a world into which we are inescapably subsumed. Nowhere is this appreciation more apposite than within the high-flow systems rigged for physical and psychological healthcare. Patients and doctors both need sanctuary from the dehumanisations of a speeded-up and grossly technologised world. Patients unremittingly want humanised care. Physicians deserve a humanised environment, as expressed by my American colleague from his experience as a doctor in family medicine. Similarly, the finest surgeons are comparable to highly-strung racehorses. Thoroughbreds neurotically start, fright, twitch, and need to be humanistically becalmed so they can win the next race. Collective efforts to humanise environments – against the greatest common threat : that of dehumanisation in a complexly composite world – will improve psychophysical health locally and globally. Humanism is “the way of the union.”