I had a dismal start to the second year of my psychiatric residency, and my subpar performance was noted by many faculty members. One professor approached me and told me to discuss the situation with my psychotherapy supervisor, adding, “Don’t let your supervisor sugarcoat it.” The professor knew that my advisor was an extremely kind and gentle person who would prefer to leave out the details of my performance so as not to traumatize me.
Sugarcoating the reality of a situation lessens the harshness of underlying events and sidesteps problems. But sugarcoating is exactly what we do when we soft-peddle explanations for the disparity between the outward appearance of a commitment to health and well-being and the actual practices or outcomes that fail to support this commitment. It is a growing practice seen across the U.S. in organizations or institutions that present themselves as prioritizing health and well-being, but their actions do not genuinely support or improve health outcomes.
Such deceptive practices are akin to health-washing, i.e., deceptive marketing strategies that misrepresent a product’s healthiness to consumers. In extreme instances, it may seem like sane-washing – “[a]ttempting to downplay a person or idea’s radicality to make it more palatable to the general public.”
You can choose whichever noun seems appropriate – sugarcoating, white-washing, or sane-washing – but the fact is, the gap between the reality of health care delivery and the way in which it is experienced by the public is widening.
For example, health care systems may promote themselves as champions of patient-centered care, emphasizing their commitment to high-quality, compassionate services. However, in practice, they might cut corners, underfund essential services, or prioritize profit over patient outcomes, leading to substandard care.
Insurance companies might market their plans as offering comprehensive coverage and easy access to health care. Yet, in reality, they could impose high deductibles, copays, and restrictive provider networks, making it difficult for patients to receive the care they need without significant out-of-pocket expenses.
Hospitals and clinics might advertise advanced technology and state-of-the-art facilities to attract patients. Despite this, they could neglect basic patient care standards, staff training, or maintenance, resulting in a disconnect between their marketed image and the actual patient experience.
Pharmaceutical companies might claim to prioritize patient health and innovation in their promotional campaigns. However, they could engage in practices such as excessive pricing, aggressive marketing of drugs with marginal benefits, or withholding negative study results, which undermine true patient welfare.
Employers might implement wellness programs and promote a healthy workplace culture, yet fail to address fundamental issues such as toxic leaders or excessive work hours that contribute to employee stress and unwell providers.
Policymakers might publicly endorse health care reforms and initiatives that promise to improve access and quality. However, the actual policies may be underfunded, poorly implemented, or designed to benefit special interest groups rather than the general public.
The discrepancy between health care promises and practice is especially problematic in mental health care.
Health care organizations may launch mental health awareness campaigns or programs that look good on the surface but lack substantive support or funding. For instance, a hospital might promote mental health awareness during Mental Health Awareness Month but fail to provide adequate mental health services or support for patients and staff year-round.
Some institutions might implement minimal mental health resources, such as a token mental health professional on staff or an employee assistance program (EAP). But beyond the limited number of sessions provided by EAPs, there loom long wait times to be seen for therapy in the community, as well as high costs and insufficient—and in some cases, inadequately—trained in-network providers.
Employers in the health care sector might promote a culture of wellness and mental health support for their employees, but fail to address the underlying causes of stress and burnout, such as excessive workloads, inadequate staffing, or lack of support for mental health days.
Health care services, both physical and mental, are on the verge of chaos and collapse. A 2024 report of The Commonwealth Fund compared health system performance in 10 countries and concluded: “The U.S. continues to be in a class by itself in the underperformance of its health care sector. While the other nine countries differ in the details of their systems and in their performance on domains, unlike the U.S., they all have found a way to meet their residents’ most basic health care needs …”
I hope the Commonwealth Fund report and similar exposés will put an end to over-selling the virtues of America’s health care system and prompt meaningful reforms.
Arthur Lazarus is a former Doximity Fellow, a member of the editorial board of the American Association for Physician Leadership, and an adjunct professor of psychiatry at the Lewis Katz School of Medicine at Temple University in Philadelphia, PA. He is the author of several books on narrative medicine, including Medicine on Fire: A Narrative Travelogue and Story Treasures: Medical Essays and Insights in the Narrative Tradition.
