stigma encourages morality-based treatment – no more…
Medical stigma often faults patients:
weight as a measure of work ethic
addiction as a measure of self-control
physical disability and pain as a measure of strength
mental or psychological divergence as a measure of virulence
and so on…
The root of many stigmatized concepts in medicine is the subjective judgement of a person as good and worthy. However, what makes a person good or worthy changes with perspective and life experience — it's personal. Therefore, each physician's judgement differs from another physician; it will also differ from patients' realities.
It is easier to process others and events of life as good or bad. Categorizing in this way provides a sense of personal morality, which establishes a source of confidence and validation. To see a person who seems to conflict with our fundamental "good" category causes us to automatically categorize this person as bad. This is harmful since reality is usually complicated by factors such as duality, perspective, emotions, culture, and more. Limited frame of reference begins the development of stigma.
I have recognized through my experience as a patient and observing medical student that judgements of patients tend to be personal. This personal judgement is natural and automatic, and it guides medical decision-making just as it would guide personal interaction outside of medicine. Sometimes it is not as difficult to relate to another when we have had similar experiences with similar perceptions. For example, my judgement of a patient in pain or managing anxiety is influenced by my personal experience of managing my own chronic pain and anxiety; so, I may judge treatment differently from someone without these ailments. Patient distress or displeasure and its impact on our emotions at the time can also affect what we see in them, and affect what we decide is “good” for them.
The best way to make safe judgements is to get as close to the other person's perspective as we can. This can be done through awareness and receptive attention during interaction. The goal is not to remove personal perspective; it is to redirect our mentality from a weighted, inflexible comparison to a practicable, lucid learning. The goal is to relate to the person we see.
If we shift from a strict-comparison assessment to an adaptable-learning assessment, personal experience will not be the determining fact of a patient's treatment. This is an important step for eradicating morality-based treatment.
Morality-based treatment is medical treatment and decision-making rooted in personal measure of morality or good vs. bad.
I challenge the physician community to adjust our approach to others from generalized "goodness" based on a fixed scale of morality to allowing space for an individual person to be as they are. We can completely center the person in front of us who needs medical guidance by approaching with the following questions:
• What do I witness in this person?
• What are they sharing with me in what they're saying and doing?
• What would it be like to have their experience?
• How can I see through this person's eyes and apply medical knowledge in order to facilitate achieving their health goals?
In appreciating views of our patient’s life, we can identify behaviors, habits, and circumstances that we may have missed without doing so. Empathy can point to unrecognized addictions or disprove suspected addictions (for example) and help us to intervene effectively. Empathy is paramount to comprehensive medical decision-making.
The swift change in demeanor toward controlled-substance use could be related to the emotional charge communicated by our law-making officials and concerned citizens. While these are absolutely understandable, many assumptions made are confounded by insight. To release harmful stigmas associating variance and less-understood illnesses with criminality and "bad", we must not hesitate to be wholly present for those we seek to help.
Interactive, accommodating relationship is mandatory to personalize medicine and eliminate fallacies that hinder appropriate patient care. This is how we improve patient outcomes, i.e. a person’s change within life after treatment. Ensuring safety for our patients within patient-physician relationships requires a level of intimacy and vulnerability, which will subsequently inspire compassion. With compassion we can better resolve social medicine's dilemmas and prevent losing persons we have failed to see through our muddied viewpoints.
