In an interesting article on Medscape.com, “Have We Missed the Hidden Cause of Medical Overuse,” the author raises a provocative issue about medical overuse. He cites the story of when a mother kisses the scrape of a toddler, “No healing takes place, yet both parties appreciate the ritual.” Continuing, he states, “The ritual shows how we might be programmed to both seek and offer healthcare even when it isn’t medically useful.” He believes this is “Conspicuous Caring”.
The provocative conclusion is that healthcare isn’t just about health; it’s also a grand signaling exercise called conspicuous caring. If healthcare was only a transaction about getting well, you would expect patients to pay for (and doctors to prescribe) only treatments in which benefits exceed costs. Conspicuous caring provides an alternative explanation for demand that leads to consumption that exceeds the point of value. And in modern medicine, demand resulting from conspicuous caring can be masked by the real healing that often occurs.
– John Mandrola M.D.
The thesis of the article is when providers appeared to be doing something that will be perceived as helping the patient, this conspicuous caring provides the public with a tangible signal of medical quality. The article’s primary focus is the evaluation of a book The Elephant in the Brain: Hidden Motives in Everyday Life by Kevin Simler and Robin Hanson and how our thought processes impact on healthcare delivery.
The question that arises from this discussion of Conspicuous Caring is – If this is written into our DNA, how do we make it a constructive force in healthcare delivery? When doctors prescribe tests, procedures and prescriptions to simply satisfy our need to perceive them as caring, the articles author argues this is what leads to medical overuse and the high cost of care in the United States. On the other hand, it may well indicate that our providers are losing the ability to communicate with us in a meaningful way that expresses a caring professional.
I spoke to a retired healthcare professional recently who indicated he had seen his cardiologist and he felt the doctor had focused totally on the data available on his computer and never had an empathetic interaction with him as a patient. This lack of conspicuous caring motivated this knowledgeable retired healthcare professional in his 80s to seek out a second opinion. What this real life interaction teaches us is there is much more to the healing process then the technology driven data points that are available to professionals.
Today, the need to exhibit empathy, concern and understanding is very important to the recipient of care.
In another instance I watched the interaction between a hospitalist and patient. The hospitalist never took his eyes off of the computer as if it were the one requiring treatment. If we define Conspicuous Caring as our professionals providing empathy, compassion, and concern, we might achieve the ultimate by reducing the cost of healthcare and creating real patient satisfaction.
The patients in our healthcare system are beginning to feel like a commodity in a highly mechanized, technology driven system. Their primary care physician no longer makes rounds at the hospital to check on their progress; the patients are visited by the hospitalist who is employed to accelerate the patients’ discharges from the facility and are strangers to the patients. It is no wonder, in this process, why people seeking out healthcare feel estranged.
The physicians, in their defense, are under increasing pressure to see more patients and have reduced amounts of time to really engage in the process of caring. As a result, they turn to Conspicuous Caring through the writing of prescriptions for lab tests and diagnostic tests to give their patients the appearance of being engaged in their care. There have been studies made that indicate as physician’s face increasingly fatigues as the day goes on, the physician is more inclined to order additional diagnostics because the coping and decision-making processes for them have broken down.
The driving force for the creation of Curus was an increased understanding that the discerning healthcare consumer needs the expertise, sensitivity and a caring voice to help navigate through the healthcare process. The idea that we receive more attention and empathy from our wealth managers than from our healthcare providers became a compelling reason to create Curus to be that advisor, and empathetic voice – providing both direction and comfort for our members. Our tagline, “Because health is the greatest wealth there is,” reflects our commitment to protect your most invaluable asset, your well-being.
We need to place caring as one of the highest priorities in the delivery of healthcare. If we achieve this we will substantially reduce Conspicuous Caring.