The Soul of Care: The Moral Education of a Husband and a Doctor
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process of somatization, or embodiment, in which bodily symptoms without any clear-cut biological pathology can impede normal life for patients, and can result from depression, anxiety, and problems in the workplace or home.
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the symbolic anthropology advocated by Clifford Geertz at the University of Chicago. This approach emphasized the role of meaning in people’s lives, meaning that became organized by a culture into systems that connected images and ideas with emotions and values. This way of thinking suggested that the world is physically real and tangible but at the same time is defined, categorized, and regulated by a cultural web that ensnares politics and economics. Cultural systems integrate meanings, feelings, and behaviors into local worlds that influence how we experience and express the body, how we construct social relationships, and how we evaluate moral and social goods.
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In the 1960s and ’70s, big business and big government began to take over whole domains of practice, conglomerating and forcing primary care, specialties, diverse technological services, and just about every kind of treatment intervention into one many-tentacled system. These powerful institutions converted physicians and nurses and the other health services personnel from independent professionals into a vast army of wage-laborers. Health care became a product. Hospitals and clinics produced it, and patients consumed it. Big medicine helped generate a big medical-legal system to respond to increasing patient complaints about their experiences of bureaucratized health care. Litigation flourished to such an extent that practitioners ran scared, spent millions of dollars on insurance, and found refuge in algorithmic best-practice guidelines (simplistic one-size-fits-all cookbook recipes). By the 1990s and 2000s, researching evidence-based interventions on the computer replaced experience-based clinical caregiving with the actual patients. Statistics counted more than wisdom. Practitioners spent more time on the phone, speaking with insurance company representatives and health plan bureaucrats, than they did talking with patients. Corporate medicine employed the same tools corporations used to respond to unhappy customers and to attract new customers. Trainers, based on experience with airline flight attendants and restaurant waitstaff, taught health professionals how to simulate emotions like empathy. They talked about “resilience” as if patients and family carers were rubber bands who would spring back into their original shape no matter how cruel and severe the physical and emotional assault they endured. Viewed as customers, patients were socialized to evaluate health care purely in economic terms of efficiency and cost. Physicians, in response, picked up the same language and ditched the language of medicine as a moral calling and care as a moral responsibility. And so on and so on, until we have arrived at the dire straits we are in today, where there is cause for a real fear that caregiving—on the deeply human level where it matters most—could disappear from professional practice and become more highly constrained even within the formerly protected space of families and friendship networks. Patients and caregivers alike felt besieged, as if they were losing their safety net, their “haven in a heartless world,” as the late Christopher Lasch, a historian of twentieth-century America, put it. Something was happening, and happening fast, to the US health care system, creating a rapidly fragmenting and increasingly chaotic and dysfunctional nonsystem.
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our suddenly medicalized existence.
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the deep core of values and sensibility that constituted her personhood,
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in my innermost being all I could really control was how I reacted, how I responded.
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Chinese tradition, which embraces the idea that human life often ends in disappointment and failure. Nonetheless, the moral person must persist and endure, thereby elevating his or her own human qualities even in the face of bad outcomes.
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all of us hunched over our screens, spending more time dealing with constraints on how to do our jobs and less time simply doing them. And the only choice we seem to have is to adapt to this reality or become crushed by it.”*