Sagar: The key to health care is caring

Katie McLean | Staff Photographer
Stephen M. Sager delivers Wednesday’s Interfaith Lecture, titled “Spiritual Malaise in Modern Health Care,” in the Hall of Philosophy.

In Dr. Stephen Sagar’s view, medicine has become a dystopian business enterprise. There are so many rules and regulations for health care professionals to deal with that it is becoming increasingly difficult for them to provide compassionate health care. Bureaucratic systems are taking the soul out of health care organizations, he said, by pulling physicians and nurses out of the front lines and into a culture detached from patients, one that values efficiency and productivity over personal interaction. “You may be surprised to learn that physicians are losing their power to make decisions and moral choices,” Sagar said. “A major contributor to that is micromanagement of the physician and nurse by a burgeoning bureaucracy of administrators and managers who impose a top-down approach to controlling clinicians.”

Sagar is a radiation oncologist and professor of oncology at McMaster University. He spoke at 2 p.m. Wednesday in the Hall of Philosophy with an Interfaith Lecture titled “Spiritual Malaise in Modern Health Care.”

“If the bureaucracy of organizational management has squeezed the spirit from many physicians and nurses and is destroying the soul of medicine, many physicians have lost faith in the culture of health care,” Sagar said.

At least 25 percent of physicians admit that they wouldn’t have become doctors if they knew then what they know now, he read from a study. Almost 50 percent would deter their children from entering a career as a medical doctor — and Sagar is one of them.

Polls also reflect a profound patient dissatisfaction with health care. But the blame shouldn’t be entirely on the doctors, Sagar said. After going through a demoralizing training process and then having to be on call for days at a time, doctors are highly susceptible to manipulation by administrators.

“They’re often emotionally blunted, suffer from concrete thinking, may become cynical and are disillusioned with their ability to make a difference in health outcomes,” he said. “This has been termed ‘burnout’ and is created by chronic exposure to a dysfunctional training and exposure to a toxic organizational culture.”

The 1980s were a turning point in the independence of physicians, Sagar said. A new breed of administrator emerged to serve the needs of a growing consumerism in health care. The tendency to see patients and eventually physicians as data did not mix well with the interactive care that physicians were trained to practice.

“In the past, senior nurse managers were called ‘matrons’ and ‘sisters,’ ” he said. “And they used to interact directly with the patients. The matron of a hospital with maybe 800 patients would literally do a walk around every day with the sister of the ward. She was the senior manager of that hospital, but she would still go out of her way to see every patient in every ward and do a round with a sister.”

The matrons’ modern equivalents are called “executive managers” or “supervisors,” Sagar said, and they are detached from the patients they are meant to serve.

“There has been a gradual de-professionalization of medical staff, moving them subtly away from patient advocacy to be agents of senior policy implementation and resource controllers,” he said.

Many nurses now spend more time electronically charting procedures than they do interacting with patients or speaking with fellow colleagues. And much of that charting, Sagar said, is done to please the administration.

“Overzealous documentation, however, does distract the staff away from their patients and into a dystopian world of  management procedures focused on … legal protection — which of course is important — economic outcomes and a subservience to virtual performance rather than authentic performance,” he said.

Activities like talking to patients, feeding them, washing them and manicuring their nails may be viewed as inefficiencies in the eyes of managers, but to Sagar, they are important in forming relationships. Relationships in themselves can be therapeutic, and they can give physicians opportunities to evaluate their diagnoses.

Quoting Victoria Sweet, author of God’s Hotel, Sagar said, “The secret in the care of the patient is inefficiency. The good doctor makes the right diagnosis and prescribes the proper treatment. The better doctor walks with his patient to the pharmacy. And the best doctor waits in the pharmacy until her patient swallows the medicine.”

The physician must again become the patient’s advocate, Sagar said. Doctors need to be politically active in debating the future of health care policies on behalf of the patients, rather than with their own interests in mind.

“Medical science and the art of practicing medicine are not the same,” Sagar said. “The former is merely a tool, whereas the latter requires judgment and morals. The medical practitioner is in a privileged profession, a priestly one that takes on more responsibility than a technician. Without the physician, who will integrate the complex and implicit values of our society regarding such issues as disease and death? If physicians cannot be trusted, who can be?”