My deepest concern about modern medicine is how it increasingly overlooks the humanity in the patients it's supposed to serve. At a recent panel in Cambridge that brought hospital leaders together to discuss leadership challenges in medicine, the word patient was mentioned only once in a three-hour session. With the focus on cost containment, accountable care organizations, shorter hospital stays and risk mitigation, only one hospital leader mentioned that a hospital's mission was providing the best patient care, and when this was done, solutions to the other issues followed.
Two days later I attended a book reading that brought medicine back to its values. In her elegant and profoundly inspiring memoir, "In Awe of Being Human: A Doctor's Stories from the Edge of Life and Death," Dr. Betsy MacGregor recounts her intimately professional relationships with patients entrusted in her care. These inspiring accounts demonstrate how the human touch is necessary to providing true medical care and also to enduring meaning and purpose in the lives of medical professionals. But this is a fast-paced world, one where new technology is cranked out at a remarkable pace, and our reliance on it heightens, seemingly everyday. While we're more connected to each other than ever, we're more disconnected from purposeful face-to-face interactions. MacGregor speaks about this "uneasy alliance between tenderness and technology," which she describes as dance partners: "... one subtle and sensuous, the other practical and proud ... sometime they seemed very much at odds, as if the presence of one discredited the other; other times their movements flowed seamlessly together, suggesting that, alone, each one was incomplete."
In the world of medicine, where the physical exam is often given short shrift in favor of ordering a menu of tests, we miss some of the most important information that is right before us. We miss the connection, and the empathy, of which the key components are making meaningful eye contact, noticing the facial expressions, emotions, and postures of others, attuning to the tone of voice, hearing the whole person and noticing our own responses to others.
MacGregor's stories testify to the life-affirming power of empathy: listening, touching, and seeing another person. Had MacGregor not picked up three-year-old Roman -- who was diagnosed but not improving -- and met his gaze, she would have never seen the pleading look in his eyes that shook her to the core. She immediately ordered a CAT scan and a few hours later learned that Roman had an abscess that encroached on his trachea, and he was already undergoing surgery.
Another resonating report involves the power of listening. After a teenage pregnancy Migdalia landed in a group home, rejected by her parents. Her baby died in-utero in a gang shooting during the 7th month of pregnancy. Migdalia was referred to MacGregor because she wasn't deemed to be grieving her loss appropriately, and was she masking a deep depression? With a gentle approach, MacGregor heard her story. Before the pregnancy, Migdalia said she hated her life -- it was ugly, mean, and unfair. Her unborn baby boy gave her the connection and joy she'd never experienced. The bullet that killed her baby missed her aorta by a millimeter -- "death was coming for me and he saved me, in more ways than one," she said. Her baby had helped her find her life and give meaning and hope to it. She cherished her son and wanted to honor him by taking his gift and using it well. Through careful listening, rather than prescribing antidepressants, MacGregor helped Migdalia realize her story was one of heroic humanism.
Our humanity with patients is part of the dance of medicine. Alone, it is not always enough to care deeply. Medical technology is part of the miracle of medicine. However, without humanity, we miss the essence of meeting others at their most vulnerable and frightening journeys, where an empathic partner can help them cross the most poignant thresholds of what it means to be human.
Helen Riess, M.D.
TEDx Talk: The Power of Empathy