Ego and attachment in healthcare
I feel ego and attachment is a massive issue in healthcare. It was with me, and still sometimes is.
“The ego is nothing more than the focus of conscious attention”
As healthcare providers we are encouraged to provide patient centered and informed care. This can be challenging when our ego gets in the way.
The current trend in healthcare is to advocate for “first-line” treatments that seem to have better evidence for them, in that they are more likely to help someone. If the “first-line” treatments are not providing significant benefit then guidelines will often advocate considering bringing in “second line” treatments that generally speaking have lower quality evidence that they can be helpful. These “first-line” and “second-line” treatments tend to revolve around exercise, what we might call load management, education and other modalities such as manual therapies (manipulation and massage), acupuncture/dry needling, brace use and injection therapy. Another way these treatment options are described can be “non-surgical”
Guideline-based care pathways will usually then suggest that if a patient has adequately explored a period of “first-line” and “second-line” treatments, with a limited benefit, that a surgical pathway may need to be considered. Once again this should all be “patient centred and informed” that patient clearly getting a say in what path or treatment they may or may not want to explore.
Context is king/queen, but I was following a recent discussion on social media. It was interesting to see a participant recommend that a patient, who had not adequately improved with “first-line” treatment for a tendon issue, NOT progress to explore a particular “second-line” treatment based on their opinion (citing one research article) that this treatment had “no role” in the treatment of tendon pain. Now this particular treatment certainly has some question marks about it, as most treatments do, but it is semi-regularly cited as a “second line” treatment. Now I am speculating here but I think a lot of us in healthcare become attached and biased to treatments we think are most helpful. We also become highly biased against treatments we think are not helpful and/or that we don’t use. I also think ego gets in the way in that if a patient is not improving adequately with our treatment that our ego can be “bruised” if they head off and try some additional treatment that we are highly biased against. Our ego can then get even more bruised if they improve with this treatment.
I go back to my earlier statement about providing patient centered and informed care. I feel that to do this we need to adequately explain to a patient, in a non-biased, non-attached and non-ego driven manner what we know about their condition and what treatments are recommended as “first-line” and “second-line”. Surely then the patient can make an informed decision based on what treatments they would like to explore. I can certainly understand a patient wanting to explore and “second-line” treatment if they are not adequately recovering with “first-line” treatment and are staring down the barrel of undertaking surgery in order to achieve their goals.
Become attached to various treatments and letting our ego get in the way of our role as healthcare providers is surely doing a disservice to our patients.
As Phil Jackson wrote in Eleven Rings:
“Bench the ego. I have taken a different tack. After years of experimenting, I discovered that the more I tried to exert power directly, the less powerful I became. I learned to dial back my ego and distribute power as widely as possible without surrendering final authority. Paradoxically, this approach strengthened my effectiveness because it freed me to focus on my job as keeper of the team’s vision. Dialing back the ego does not mean being a pushover”.
I like to see patients improve. Clearly we cannot help everyone, and not everyone gets better, but I have learnt sometimes we need to support patients trialing treatments that we may not necessarily think are going to be helpful. I like nothing better than seeing patients improve, regardless of whether it is through treatment under my watch, or with someone else.
Perhaps it is time to bench the ego. Don’t put your ego and attachments ahead of the patient.