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Show The process focus of TQM and CQI does not adequately address all of the changes in corporate culture necessary to provide customer-centered healthcare. TQM and CQI provide the tools to monitor, measure, and evaluate current processes, but they do not clearly address the fundamental philosophies hospitals have adopted in how patients are treated - as diseases, symptoms, or persons. Interpersonal Issues in Healthcare Although the study of medicine is firmly grounded in the "hard" sciences, the practice of medicine is very much a social science. Healthcare is an interpersonal process, and healthcare workers need to be reminded of this fact. The purely biological approach to the diagnosis and treatment of disease or disorder is incomplete in satisfying patients' needs. Their psychological and social needs must also be addressed. "The uncomfortable fact remains that doctors cannot get at diseases without dealing with patients - doctors do not treat diseases, they treat patients" (Cassell, 1991). Increases in technology have helped to transform the interpersonal art of medicine into a cold, impersonal science. Medical technology has "created an array of tools with which to do things to people, thus resulting in less and less time to do things with people" (Friedman & DiMatteo, 1982). While all of the medicine, technology, and drugs are a large part of healthcare, interpersonal factors ~ social, psychological, and emotional - are also an integral part of the healing process. According to Cassell (1991): "In the case of the art of medicine versus the science of medicine...both seemingly opposed points of view can be correct, since they are concerned with two different things, although they seem in opposition because both perspectives are incomplete in themselves. There is no question that if you want to treat sick persons based on the mechanisms of disease - and any other way would be inadequate - then science is essential to medicine. On the other hand, if you want to treat sick persons as the persons they are ~ and any other way would be inadequate ~ then art is essential to medicine." The art of medicine and the science of medicine are both important, but, more and more, healthcare providers concentrate on attacking disease and physical deterioration with an almost "assembly-line" mentality. They see the disease, but forget the diseased. "It is the Midas touch of medicine, that the sick and suffering are forgotten so that their illnesses can be healed" (Tisdale, 1986). The following is an example of such displaced priorities: "The Knee" We are on attending rounds with the usual group: attending [physician], senior resident, junior residents, and medical students. There are eight of us. Today we will learn how to examine the knee properly. The door is open. The room is ordinary institution yellow, a stained curtain between beds. We enter in proper order behind our attending physician. The knee is attached to a woman, perhaps 35 years old, dressed in her robe and nightgown. The attending physician asks the usual questions as he places his hand on the knee: "This knee bothers you?" All eyes are on the knee; no one meets her eyes as she answers. The maneuvers begin - abduction, adduction, flexion, extension, rotation. She continues to tell her story, furtively pushing her clothing between her legs. Her endeavors are hopeless, for the full range of knee motion must be demonstrated. The door is open. Her embarrassment and helplessness are evident. More maneuvers and a discussion of knee pathology ensue. She asks a question. No one notices. 84 WHAT ABOUT THE PATIENT? |