Managing the Psychology of Health Care: What it means and what it is worth

BACKGROUND Health care is perhaps the most complicated of services. While most services in the business world are challenged by the diversity of clients and variability in their needs, health care must face this challenge with tremendous pressure from other factors. On the one hand, the stakes are extremely high, and the demand for excellence is unmatched by those placed on other service providers. On the other hand, the whole activity takes place not only in the tangible world of wards and beds, but also in the abstract world of psychological and sociological forces that guide all stakeholders, from those holding the scalpel to those holding the chequebook. While every issue in health care has its own shadow of debate and controversy, there are certainly moments of ephemeral consensus. The role of the patient in clinical decision making has been revisited along with the social and environmental changes in Western society over the past century. These include the acceleration of information exchange, increased awareness of rights and a steady erosion of physicians’ perceived omnipotence, partly a result of the two previous developments. What we have today is the Partnership model, an acceptable model of the patientprovider relationship, whereby the patient is not a passive recipient of a series of health-related procedures, but rather an active participant who holds the final word on clinical decisions. This arrangement raises some very interesting questions. The first wave is superficial, asking what the evidence is for it, against it, and what we can expect from this model from the perspective of patients and providers. The second wave asks about the hidden dynamics. Is an increased role for a patient really a dilution of expertise? Regardless of the answer, what happens to this current model in practice? Do the heightened emotional states and psychological distortions affect the patient’s view of the situation to the point where they may not be acting in their best interests? This introduces the ethical question of determining best interests and delegating the authority to pursue them. With all these issues to be sorted out, how can health care managers plan to remove the impurities from the patient-provider relationship to optimize health outcomes?