Portal de Periódicos da CAPES

Are you an artificial person? Lessons from Mid Staffordshire

2013; Elsevier BV; Volume: 99; Issue: 3 Linguagem: Inglês

10.1016/j.physio.2013.04.004

1873-1465

Andrew Soundy, Carolyn Roskell, Brett Smith,

Patient-Provider Communication in Healthcare

The recent Francis report [ [1] Francis R. Report of Mid Staffordshire NHS Foundation Trust public inquiry. The Stationery Office, London2013 Google Scholar ], from Mid Staffordshire NHS Foundation Trust, highlighted evidence of National Health Service (NHS) services devoid of care and compassion, shocking the nation. It is difficult to understand how individuals choosing to become healthcare professionals (HCPs) could reject their professional values and behave in such a counterintuitive way. A major reason why patients may perceive their care to be inadequate is attributable to what is termed the ‘artificial person’. According to Wolgast [ [2] Wolgast E. Ethics of an artificial person, lost responsibility in professions and organizations. Stanford University Press, Stanford1992 Google Scholar ], the artificial person is one whose words or actions are considered to be the actions of another person. By using the organisation, in the case of the NHS, the artificial person may be an HCP who speaks and acts in the name of, and on behalf of, others. This helps to remove the personal responsibility that HCPs feel towards their patients. Due to perceived limited control over their own time management, a lack of time allocated to being with patients [ [3] Braddock C.H. Synder L. The doctor will see you shortly: the ethical significance of time for the patient–physician relationship. J Gen Intern Med. 2005; 20: 1057-1062 Crossref PubMed Scopus (79) Google Scholar ], and time pressures [ [4] Frank A.W. The renewal of generosity. University of Chicago Press, Chicago2004 Crossref Google Scholar ] associated with deadlines and increasing administrative demands, HCPs end up toeing the line set by managers, senior staff, doctors and administrators. Examples of responses from artificial persons to patients include: ‘I’m only following orders’, ‘It's not my fault, and I wish I could help, but it's not the policy of our hospital’ and ‘It's not my job, but if you go and see X then they might help…’. In North America, the prevalence of HCPs becoming artificial persons is increasing [ 2 Wolgast E. Ethics of an artificial person, lost responsibility in professions and organizations. Stanford University Press, Stanford1992 Google Scholar , 5 Lindsay G.M. Thinking narratively: artificial persons in nursing and health care. Nurs Educ Today. 2008; 28: 348-353 Abstract Full Text Full Text PDF PubMed Scopus (5) Google Scholar ]. The findings revealed that the effects of an artificial person on the patient are: perceived lack of good medical care and compassion, feelings of anger, and reduced adherence and motivation within care to maintain or change health behaviour. The findings also revealed that becoming an artificial person led to HCPs feeling demoralised, becoming someone they do not want to be, and leaving their post.