A physician
recently took to the Internet in a blog featured on Fox,
titled In the war on illness, the real Victim is Empathy.
There has been
ample discussion of the "great divides" in America, rich versus not,
fat and thin, academic, racial, political, gender; the list goes on and on. Dr.
Jame Abraham explains to us in this post that we must also accept that "doctors
and patients exist in two distinct worlds: the world of the healthy and the
world of the sick."
He likens this
to a culture divide. The two groups simply do not understand each other. Like
the theme in some Coke commercial, Dr. Abraham says "the only language
that connects these two worlds is kindness and compassion." It is this
commonality that can overcome the disconnect and communication barrier. He says
we need physicians that are "fluent in" compassion.
Dr. Abraham's
analysis resorts to the age-old dispute of nature v. nurture. He contends that
physicians are naturally good people, and that the decline in medical empathy
is a product of nurture. Our educational process, he explains, is training
empathy out of medical professionals. He claims that "studies have shown a
sharp decline in empathy by the time students finish medical school."
If that is not
alarming enough, he continues, explaining that physician "compassion
continues to drop during residency and fellowship." So, by the time the
professional "is a physician with patients depending on them,"
empathy and compassion are at an all time low. Those we look to for guidance
and expertise in our times of need are trained not to have empathy for our
complaints or situation?
I ran into a
physician recently. He lamented his income and complained that his brethren
were seeing twice as many patients daily, compared to his practice. He asked me
"if you could double your income tomorrow, would you?" I was
surprised that his focus seemed to be money and his envy of his brethren was a
bit disconcerting. A great many commentators lament that professions like law
and medicine have turned into businesses; some degree of the professional
motivation lost in the daily grind to meet overhead, and produce profit.
Dr. Abraham
explains that empathy is not the victim of neglect. The medical education
process is intentionally eradicating this troublesome emotion from those who
will provide us medical care. His contention is significantly in line with the
lament of the business of medicine. He says that medical students begin
the process with "dreams and aspirations of being a healer of sick."
But they are then confronted with "the crucial task of mastering
technology." The "good" physician is the one who can best master
the data and the equipment that produces it.
The news is full
of intriguing stories of medical technology. It seems a day does not pass
without news of a new device, test, or treatment. There really is a great deal
going on in the world of science and medicine. They are discovering treatments,
perfecting devices, and so many promise great things for our future. Recently
this has included new drug approaches to melanoma,
electronic skin for measuring oxygen, and a
variety of tech tools for management
of diabetes. Every day seemingly brings an interesting medical technology
breakthrough story.
But Dr. Abraham
says that our medical education now is to "teach students to be, among
other things, technicians who treat the human body as a collection of data, and
we train them to be proficient in collecting and analyzing that data."
Ours has become a data-driven society generally as computers have made
collecting and summarizing data increasingly inexpensive. Dr. Abraham concedes
that to an extent, "focusing on this type of training makes sense."
He cautions, however, that this focus can harm the doctor's relationship with
the patient.
I have written
about Watson, and the amazing innovation that is occurring in artificial
intelligence. A computer named Deep Blue beat the best humans in chess, and a
computer named Watson beat us on Jeopardy. (cue Weird Al, I Lost on Jeopardy).
Computers have evolved from performing repetitive and rote tasks. They have
begun to think, and while we have not reached 2001
A Space Odysee (in which the
computer locks Dave out of the space ship), computers are involving into thinking,
learning devices.
Dr. Abraham says
that "if being a doctor was only about having a razor-sharp memory and
delivering the right diagnosis, then IBM’s Watson would be the epitome of the
'perfect' doctor." We have seen Hollywood glorify the role of physician,
finding the elusive clue or symptom, a la House and others. What if a computer
could be engaged in the pursuit of appropriate diagnosis?
It turns out
that IBM's Watson is currently attending medical school Dr. Abraham says Watson
is "better than any physician at computing, connecting and analyzing
data." Watson has "read
and memorized thousands of medical books and journals and is much faster than a
human brain at conjuring up the right answer." It may be the epitome of
the data analyzing, data-driven doctor.
Despite Watson's
great success, speed, and efficiency, Dr. Abraham points out "there are
some things Watson simply can’t master." More aptly, perhaps "can't
master" yet. But the point he is making is that computers cannot yet form
true relationships. And thus, we return to the real theme today, empathy.
To illustrate,
Dr. Abraham describes his relationship with one patient who ignored a mass
until ultimately presenting with stage-4 breast cancer. This is a serious
diagnosis, and the patient "was
so unhappy with the doctor who diagnosed her, that she was considering not
pursuing treatment." She had multiple complaints about the diagnosing
physician. This is not as uncommon as one might expect. I have run into a fair
number of patients over the years who eschew regular medical care because of
their perceptions of the provider.
This patient
complained to Dr. Abraham that the diagnosing physician “was in my room for
less than ten minutes;" that "he didn’t answer any of my questions;”
that "he said he cannot cure this." and little more. Dr. Abraham says
that she "didn’t feel like she could rely on or connect with" the
diagnosing physician. She later presented for care with Dr. Abraham, and
described her familial experience with cancer (anyone who has seen a loved one
go through chemo will have thoughts on this), and her reluctance for the
chemotherapy journey. She expressed only one desire, to live to see a
granddaughter's high school graduation.
Thus began a
doctor/patient relationship, with a simple goal, sustaining toward a particular
future event. As Dr. Abraham puts it, together they found "the only thing
that mattered to" the patient. He feels that despite its incredible access
to knowledge and speed, Watson would fail in this setting because it is
"emotionally unintelligent."
Dr. Abraham
contends that Watson cannot connect because it cannot (yet) "smile, touch,
hug and connect." Though this is an indictment of a computer, the point is
clearly directed at humans. As young students strive to amass information, to
perfect their data collection and analytics, strive for the right answer, they
are emulating Watson. Dr. Abraham suggests that Watson should be striving for
more human traits, and the irony is that those who already possess them are
instead striving to be more like the computer.
He asks "is
it possible to teach students and young doctors to connect with patients?"
He contends that compassion is not easily learned. This seems at odds with his
original premise that suggests we all have compassion, but the medical education
system is currently training it out of doctors. Perhaps a good start, rather
than teaching compassion, would be to stop suppressing or devaluing the
compassion and empathy already there? He concludes that "there are key
aspects of health care that can’t be reduced to numbers." They require
listening to the symptoms, but beyond that to the patient's fears and
motivations.
Dr. Abraham has
some suggestions for physicians. They bear reiterating. He says it is not about
the amount of time a physician spends with the patient, but about the quality.
He says "whether a doctor spends five minutes or 60 minutes with someone,
each patient should be treated as the most important person to the doctor
during that time." That seems simple enough. Be present when you are there.
That is good advice for any relationship.
He says that
"every patient is truly unique and we must do our best to understand each
one as a whole person." Understanding concerns and motivations is a
critical element in helping people with their medical conditions. Why do they
feel as they do about their situation, what experiences, fears and concerns are
influencing their understanding and expectations?
Dr. Abraham says
that the physician has to engage. He claims that success is dependent upon the
formation of a partnership between patient and physician. This, he explains,
forms trust and confidence. Through that, patients will "open up and truly
get on board with their treatment plan." Once again, this element of
partnership and trust is valuable to any human relationship.
In the end,
there remains a great deal about medicine that is not science. There is a great
deal that is art, and much of that appears to be the art of human relations.
Will we strive to make the automatons like Watson more human, or should we find
a way to have our human doctors retain more of their humanity and emotions?
While we are at it, perhaps attorneys, adjusters, risk managers, and more could
benefit with the same advice for their relationships?
Food for thought.