An excerpt from Beyond Diagnosis: Perspective in Medicine and the Human Experience.
As my career advances, I have been reflecting on this increasing standardization and what sometimes seems to be a dehumanization of medicine in the United States. While technology has the potential to help us bring humanity back to the forefront of medical practice while also improving diagnosis and care, much of the human element has been lost since my early days of residency. I want to preserve this in my memory.
I was required to study the humanities, history, and philosophy in medical school. These books and classes heavily influenced my thinking about medicine. They asked questions like, “What is well-being?” “How do humans face death?” and “What is our relationship and our responsibility to our fellow humans?”
Today, more than ever, young doctors would benefit from the great works of literature and philosophy. In the face of a growing body of technical knowledge and increasingly stringent education funding environments, they are often given no incentive or opportunity to study the humanities and the liberal arts. They are exceedingly good at performing procedures and interpreting lab values and are often familiar with biochemical pathways that were unknown to science when I first practiced medicine. But I see them suffering when it comes to the human art of medicine.
Their training on how to talk to patients, break bad news, and support the whole person seems perfunctory. These young doctors have been taught in such great detail their obligations to standard reference ranges, clinical best practices, and metrics of success that machines can measure. They need more clarification about what they can afford to spare regarding time and energy to listen to patients and consider their wishes. Some seem to struggle with their sense of purpose, especially in an environment that often pressures them to take considerations other than patient relationships into account in their daily decisions.
I hope improvement is on the horizon with the advancement of Artificial Intelligence, which is already being used in some instances to read radiological scans before being manually reviewed and approved by radiologists. If used properly, such technology could ease the burden of memorizing infinite facts and figures and allow future doctors to focus on stewardship of the patient as a human being in a human patient-doctor relationship.
But we aren’t there yet. We all must vigilantly guard the human side of medicine, which is unlikely to speak for itself in meetings about time metrics, budgetary efficiency, and treatment decision algorithms.
Some older doctors believe in the primary importance of the physical exam. Examining patients fully requires physical touch and perceptive, individual attention. It is an empirically superior way of gathering comprehensive information about a patient’s whole-person health status compared to the cursory touch-free 15-minute visits often encouraged in health systems today.
This degree of physical contact and patient attention improves healing outcomes. This is not a superstitious idea; we now know that healing and growth are strongly affected by stress hormone levels and that social support, skin-to-skin contact, and a patient’s belief that they are being healed can create biochemical changes conducive to healing.
I have observed that, for better or worse, I can often predict which of my patients will recover and which will spiral downward based on their first visits to my clinic. It is the ones who trust me and feel safe with me who often make full recoveries. I do not believe this is an accident.
As such, I urge all of us, doctors and patients alike, to defend medicine as a humanizing art in the years to come. While empirical research and double-masked controlled studies are things of true wonder and awe, patients are complex systems. We cannot treat patients like a mere set of numbers and be truly successful at optimizing their outcomes if we do not understand their stressors, environment, the actions that affect their health, and the drivers of those actions.
We owe it to ourselves and our patients to preserve the humanizing art of medicine.
Francisco M. Torres is an interventional physiatrist specializing in diagnosing and treating patients with spine-related pain syndromes. He is certified by the American Board of Physical Medicine and Rehabilitation and the American Board of Pain Medicine and can be reached at Florida Spine Institute and Wellness.
