Lens Of Care Experience
Understanding the experience of the patient through the lens of care
Introduction
Drawing on my own ethnographic findings, and further enriched with that of others in a hospital context, this essay will deconstruct a patient’s experience of care in an intensive care unit (ICU) and place different aspects of it within a broader theoretical framework of care. Primarily, I will discuss how and why a patient in an ICU experiences feelings of de-humanisation. This discussion will elucidate the changes that a person goes through as they become a patient within a hospital, during which they are subject to a total uprooting of normal routine and an adjustment in relationships that they have with their own body. From these points, the theme of power …show more content…
will not go unnoticed, as I discuss the power dynamics at play amongst both patients and medical professionals and consider how these fit within discourse on care and caring relations. In the final section I will refer back to my primary considerations of de-humanisation. Equipped with a theoretical understanding of care as practice (Held,2005) and with consideration to emotional labour (Hochschild, 1983) I will reflect upon the extent to which care, practiced by both nurses and doctors, is essential in helping re-humanise patients during their recovery. I will argue that analysing the experience of the patient through the lens of care is useful because it sheds light upon the value of care as perceived by the patient and further upholds arguments that give ‘care’ the credit that it deserves.
Ethnographic context
In order to collect empirical data for this essay I carried out one interview with Louisa, an eighteen year old girl who spent a considerable amount of time in an intensive care unit (ICU) in a french hospital. When on holiday in France, Louisa was taken to hospital with flu-like symptoms and aching joints, and was diagnosed with bacterial Bacterial Meningitis Type C and put straight into a coma so that her body could be pumped with strong antibiotics to fight the disease as quickly as possible. Five days later, Louisa awoke with no recollection. She then endured two weeks in an ICU, totally dependent upon and attentively cared for by various doctors and nurses. For the first week she was completely bed bound and scarcely able to eat or talk. However, with the help of medical professionals she made a remarkable recovery and was discharged two and a half weeks after her initial visit. My interview with Louisa focused on the last two weeks of her hospital stay and what she could remember from the ways in which she was cared for.
De-humanisation of the patient
Building on Todres et al.
(2009), who draw attention to the de-humanising and subsequently humanising elements in caring systems, the following factors are amongst those that can be identified as what contribute to making us feel human: agency, subjectivity, uniqueness, a sense of place, togetherness and a sense of embodiment. When one becomes so ill that they are hospitalised, the person (both body and mind) is likely to go through a number of unfamiliar changes that have the potential to totally alter their usual sense of being, and further disrupt access to humanising characteristics that they are used to living with. Such changes will be enacted upon the body, internally and externally, directly and indirectly and all too often can cause feelings of de-humanisation within the patient. With view of using ‘humanisation as a value base for guiding care’ (Todres et al., 2009:69), I will begin by drawing upon Todres et al.’s (2009) discussion to follow the patient’s experience and highlight the various points at which a person becomes de-humanised as a result of both medicalised discourse and medical actions within a …show more content…
hospital.
Primarily, the becoming of a ‘patient’ is one of the first transitions people go through when they are in hospital. By entering a medical institution and subduing oneself to the scrutiny of medical professionals a person inadvertently attains the ‘patient’ status. As a result of this newly attained status, it is permitted that the person be touched and tested by medical professionals and they subsequently lose the ability to speak for themselves about their own body (Mol,2008). Through these actions the patient loses subjectivity and agency, as he/she becomes a ‘problem to fix’ resulting in objectification and passivity (Mol, 2008). The following extract from my interview with Louisa is reflective of this:
“ One of the strangest things was when the nurses would talk about me as if I wasn’t there - they’d ask things like ‘has she been given her morning dose of antibiotics?’ or ‘how much wee has she produced?’. I guess it was good that they communicated with one another, but it did feel weird to just lie they whilst they would speak about my intimate bodily movements. I got used to it though, and it’s not as if I’d ever try and stop them from doing anything”.
Furthermore, the patient is likely to experience feelings of de-humanisation as they are subject to a total change in routine and become part of a health care system which - by it's nature as institutional - the patient is in no position of control and as a result loses a sense of uniqueness. They are integrated into a world that is separate from the social world that they usually enjoy and take for granted (Todres et al., 2009), and are submitted to an alternative culture within an unfamiliar institution. They lose their usual sense of place and a sense of strangeness arises instead. This can result in feelings of isolation meaning that they have lost the sense of togetherness which, being the social species that we are, is essential to us in feeling human (Todres et al.,2009). This point was illustrated by what Louisa said when asked what the more bearable parts about being in hospital were:
“Having visitors made everything better, you don’t appreciate how much you value other people’s company until it’s not permanently at your disposal. I hated how my moments of happiness were dependant on the routine of the hospital, on the visiting hours essentially”.
Moreover, the patient experiences a change in relationship to their own body. They lose control as they are no longer able to take care of themselves in ways they are used to. By nature of the intimacy and invasiveness of the physical examination, the power that the patient usually has over their own body is surrendered into the hands of the physician, through a channel of trust in professionalism (Pappas, 1990; Kleinman, 1980). It is the only time, unlike even during sex, that one’s body can be manipulated in such a way that it is “robbed of autonomy so completely as almost to obliterate the meaning of being an actor” (Pappas,1990:202). The patient’s body is observed and controlled by the practitioner as it becomes subject to a reductionist view, and as a result the patient loses their sense of embodiment (Todres et al, 2009). This draws our attention to the power dynamic between the patient and the practitioner. The practitioner, who is in control of the patient’s body at this point in time, is the one who holds the power within this clinical setting (Pappas, 1990). Indeed, this loss of power and control further contribute to de-humanisation of the patient. Prior to addressing how de-humanisation and subsequently re-humanisation fit within care theory, I will further explore this notion of ‘power’ within a medical setting and consult its relevance to care.
Power and the doctor
Foucault’s (1963) theory of the medical gaze is a useful tool through which to understand the asymmetrical power structure between the patient and the doctor (Pappas,1990).
Foucault argues that physicians have authority and maintain great power within the clinic as a result of their medical knowledge. Their expert understanding of the pathological processes of the human body can penetrate illusions of outdated theories and unveil the ‘truth’ about the disease that a patient is experiencing (Foucault, 1963). Louisa’s answer, when asked about her autonomy in hospital, illustrates this point:
“ I had absolutely no power to make decisions about what happened to my body. But I knew that they had to do what they had to do. They would never ask how I felt about having things injected into me or rubbed all over me. I guess I just totally trusted that they were doing their job with my best interest at
heart”.
With the physician’s medical gaze (Foucault, 1963), the way that the patient experiences the disease becomes less important and there is a shift in focus away from the patient’s perception of a disease towards how the doctor judges the disease. Reflecting this shift, Kleinman (1980) highlights the distinction between the words ‘illness’ and ‘disease’ within medicalised discourse - the former referring to the way that the sick person, their families and communities refer to sickness and the latter referring to the way that medical practitioners refer to sickness and reformulate it to align with theoretical models (Samuelson, 1991). In this respect, social scientists have challenged biomedicine, arguing that as well as paying attention to ‘disease’ that attention should be paid to how a patient experiences sickness as an ‘illness’ (Mol, 2002). Doctors are assumed to be caring people and indeed they very often are. However they are also problem solvers with the capacity to treat humans like mechanical systems, addressing their bodies with biomedical language that is incomprehensible to the lay person (Littlewood,1991). Such mechanisation can be a factor that strongly contributes to patient objectification and subsequently the feelings of de-humanisation (Firth-Cozens & Cornwell, 2009; Hague & Waytz, 2012). By acting on this power dynamic, the doctor cares for the patient by working out what is wrong with them and ultimately working to cure them.
Word count: 3297
Introduction
Drawing on my own ethnographic findings, and further enriched with that of others in a hospital context, this essay will deconstruct a patient’s experience of care in an intensive care unit (ICU) and place different aspects of it within a broader theoretical framework of care. Primarily, I will discuss how and why a patient in an ICU experiences feelings of de-humanisation. This discussion will elucidate the changes that a person goes through as they become a patient within a hospital, during which they are subject to a total uprooting of normal routine and an adjustment in relationships that they have with their own body. From these points, the theme of power …show more content…
will not go unnoticed, as I discuss the power dynamics at play amongst both patients and medical professionals and consider how these fit within discourse on care and caring relations. In the final section I will refer back to my primary considerations of de-humanisation. Equipped with a theoretical understanding of care as practice (Held,2005) and with consideration to emotional labour (Hochschild, 1983) I will reflect upon the extent to which care, practiced by both nurses and doctors, is essential in helping re-humanise patients during their recovery. I will argue that analysing the experience of the patient through the lens of care is useful because it sheds light upon the value of care as perceived by the patient and further upholds arguments that give ‘care’ the credit that it deserves.
Ethnographic context
In order to collect empirical data for this essay I carried out one interview with Louisa, an eighteen year old girl who spent a considerable amount of time in an intensive care unit (ICU) in a french hospital. When on holiday in France, Louisa was taken to hospital with flu-like symptoms and aching joints, and was diagnosed with bacterial Bacterial Meningitis Type C and put straight into a coma so that her body could be pumped with strong antibiotics to fight the disease as quickly as possible. Five days later, Louisa awoke with no recollection. She then endured two weeks in an ICU, totally dependent upon and attentively cared for by various doctors and nurses. For the first week she was completely bed bound and scarcely able to eat or talk. However, with the help of medical professionals she made a remarkable recovery and was discharged two and a half weeks after her initial visit. My interview with Louisa focused on the last two weeks of her hospital stay and what she could remember from the ways in which she was cared for.
De-humanisation of the patient
Building on Todres et al.
(2009), who draw attention to the de-humanising and subsequently humanising elements in caring systems, the following factors are amongst those that can be identified as what contribute to making us feel human: agency, subjectivity, uniqueness, a sense of place, togetherness and a sense of embodiment. When one becomes so ill that they are hospitalised, the person (both body and mind) is likely to go through a number of unfamiliar changes that have the potential to totally alter their usual sense of being, and further disrupt access to humanising characteristics that they are used to living with. Such changes will be enacted upon the body, internally and externally, directly and indirectly and all too often can cause feelings of de-humanisation within the patient. With view of using ‘humanisation as a value base for guiding care’ (Todres et al., 2009:69), I will begin by drawing upon Todres et al.’s (2009) discussion to follow the patient’s experience and highlight the various points at which a person becomes de-humanised as a result of both medicalised discourse and medical actions within a …show more content…
hospital.
Primarily, the becoming of a ‘patient’ is one of the first transitions people go through when they are in hospital. By entering a medical institution and subduing oneself to the scrutiny of medical professionals a person inadvertently attains the ‘patient’ status. As a result of this newly attained status, it is permitted that the person be touched and tested by medical professionals and they subsequently lose the ability to speak for themselves about their own body (Mol,2008). Through these actions the patient loses subjectivity and agency, as he/she becomes a ‘problem to fix’ resulting in objectification and passivity (Mol, 2008). The following extract from my interview with Louisa is reflective of this:
“ One of the strangest things was when the nurses would talk about me as if I wasn’t there - they’d ask things like ‘has she been given her morning dose of antibiotics?’ or ‘how much wee has she produced?’. I guess it was good that they communicated with one another, but it did feel weird to just lie they whilst they would speak about my intimate bodily movements. I got used to it though, and it’s not as if I’d ever try and stop them from doing anything”.
Furthermore, the patient is likely to experience feelings of de-humanisation as they are subject to a total change in routine and become part of a health care system which - by it's nature as institutional - the patient is in no position of control and as a result loses a sense of uniqueness. They are integrated into a world that is separate from the social world that they usually enjoy and take for granted (Todres et al., 2009), and are submitted to an alternative culture within an unfamiliar institution. They lose their usual sense of place and a sense of strangeness arises instead. This can result in feelings of isolation meaning that they have lost the sense of togetherness which, being the social species that we are, is essential to us in feeling human (Todres et al.,2009). This point was illustrated by what Louisa said when asked what the more bearable parts about being in hospital were:
“Having visitors made everything better, you don’t appreciate how much you value other people’s company until it’s not permanently at your disposal. I hated how my moments of happiness were dependant on the routine of the hospital, on the visiting hours essentially”.
Moreover, the patient experiences a change in relationship to their own body. They lose control as they are no longer able to take care of themselves in ways they are used to. By nature of the intimacy and invasiveness of the physical examination, the power that the patient usually has over their own body is surrendered into the hands of the physician, through a channel of trust in professionalism (Pappas, 1990; Kleinman, 1980). It is the only time, unlike even during sex, that one’s body can be manipulated in such a way that it is “robbed of autonomy so completely as almost to obliterate the meaning of being an actor” (Pappas,1990:202). The patient’s body is observed and controlled by the practitioner as it becomes subject to a reductionist view, and as a result the patient loses their sense of embodiment (Todres et al, 2009). This draws our attention to the power dynamic between the patient and the practitioner. The practitioner, who is in control of the patient’s body at this point in time, is the one who holds the power within this clinical setting (Pappas, 1990). Indeed, this loss of power and control further contribute to de-humanisation of the patient. Prior to addressing how de-humanisation and subsequently re-humanisation fit within care theory, I will further explore this notion of ‘power’ within a medical setting and consult its relevance to care.
Power and the doctor
Foucault’s (1963) theory of the medical gaze is a useful tool through which to understand the asymmetrical power structure between the patient and the doctor (Pappas,1990).
Foucault argues that physicians have authority and maintain great power within the clinic as a result of their medical knowledge. Their expert understanding of the pathological processes of the human body can penetrate illusions of outdated theories and unveil the ‘truth’ about the disease that a patient is experiencing (Foucault, 1963). Louisa’s answer, when asked about her autonomy in hospital, illustrates this point:
“ I had absolutely no power to make decisions about what happened to my body. But I knew that they had to do what they had to do. They would never ask how I felt about having things injected into me or rubbed all over me. I guess I just totally trusted that they were doing their job with my best interest at
heart”.
With the physician’s medical gaze (Foucault, 1963), the way that the patient experiences the disease becomes less important and there is a shift in focus away from the patient’s perception of a disease towards how the doctor judges the disease. Reflecting this shift, Kleinman (1980) highlights the distinction between the words ‘illness’ and ‘disease’ within medicalised discourse - the former referring to the way that the sick person, their families and communities refer to sickness and the latter referring to the way that medical practitioners refer to sickness and reformulate it to align with theoretical models (Samuelson, 1991). In this respect, social scientists have challenged biomedicine, arguing that as well as paying attention to ‘disease’ that attention should be paid to how a patient experiences sickness as an ‘illness’ (Mol, 2002). Doctors are assumed to be caring people and indeed they very often are. However they are also problem solvers with the capacity to treat humans like mechanical systems, addressing their bodies with biomedical language that is incomprehensible to the lay person (Littlewood,1991). Such mechanisation can be a factor that strongly contributes to patient objectification and subsequently the feelings of de-humanisation (Firth-Cozens & Cornwell, 2009; Hague & Waytz, 2012). By acting on this power dynamic, the doctor cares for the patient by working out what is wrong with them and ultimately working to cure them.
Word count: 3297