The Importance of Human Relationships in Medicine
The year is 1870… it is a dark and stormy night in New York, as a young woman is overcome by the spirits swirling around her. We don’t know her name, just that she has been touched by the loss of her mother to cholera and a near-death experience with the same sickness. Following her illness, she started sleepwalking and developed the ability to go into trances at will. In this state, she communicates with the dead. This very night, she is in one of these trances; her father summons the well-respected Dr. William A. Hammond to investigate her condition.
First, the doctor pokes her eye with his finger to make sure she’s not faking, then he asks the catatonic girl a series of irrelevant questions with the goal of exposing her supernatural fraud. Satisfied that she is not actually speaking to ghosts, he goes on his merry way; we don’t hear anything more about her.
Two-hundred miles away in Boston, Julia Crafts Smith is struggling to care for her smallpox-stricken husband. She too has been touched by grief, having lost her father and brother, and is scared of losing her husband too. Julia’s friends shun her, afraid they will catch the disease – even the doctor, she describes “only stepped into the door, never into [her husband’s] room.” One night, a spirit comes to her, tells her to throw out the opioid (laudanum) presumably suggested by the doctor, and replace it with tea. Her husband starts to recover the next day, and she thanks the spirit for its guidance.
Most people reading this article are unlikely to think that the spiritual plane was involved in either of these episodes (depending on how much X Files you have watched), and like me, feel the knee-jerk reaction to dismiss these women’s supernatural explanations for what was happening to them. Yet, it is hard to fault them for coming up with their own interpretation. In both cases, the medical system let them down, and turned its back on them. And they turned their back on it.
In the first piece, the doctor has no interest in listening to his patient’s story, but is set on poking, prodding, and experimenting on her. In the second, the doctor is the woman’s only contact with the outside world, but offers no comfort; just a powerful (and for someone with smallpox, harmfully immunosuppressive) opioid.
Medicine has advanced miraculously since then, and yet recently, the relationship between the public and the healthcare system seems to have gone backwards. Many people feel that the medical establishment has betrayed them, whether with burdensome costs, harmful treatments (real or perceived), or simply a cold unwillingness to listen. This is further confused by the fact that misinformation in healthcare is spreading rapidly—online, through social media, and by word of mouth. Many people, especially those without access to accurate, understandable medical information, are struggling to tell the difference between what is true and what is false. These are our modern ghost stories, and they are more compelling and sophisticated than ever.
It can be overwhelming to sort through the complex and interrelated reasons why we have gotten to this place, but virtually all the issues of modern healthcare can be summed up as a shift in focus away from . The dominant relationships in healthcare today, instead of being between human doctors and human patients seem to be between inanimate things: computers, companies, and agencies jumbled in bureaucracy. As patients we spend more time in waiting rooms, talking to chatbots, and filling out online forms; as providers, overworked in overwhelmed systems, we spend more time in EMRs, less time in the room with patients, and more time in Telehealth calls plagued by bad connections (in more ways than
It is not a system designed for human beings. I think back to an idealized past, but the world of the country doctor, who lived in your community, who delivered you and your mom, and who came to your house when your grandfather couldn’t get out of bed seems antiquated, even quaint. Medicine is not so simple these days — nothing is — but that doesn’t mean that we have to continue down the road of increasingly disconnected care. The healthcare system is a behemoth, but it is one we have created, and ultimately one we can change slowly (or quickly!) just by changing our focus, by re-emphasizing human relationships.
Last February I hurt my shoulder at work. After filling out about a million forms, I made it to an occupational health clinic where a doctor came to check out my injury. I remember feeling strange that she never examined my shoulder, didn’t touch me at all, and just repeated back what I had written on my form. I’m sure working in occupational health she had seen this kind of injury thousands of times, and her diagnosis and recommendations were appropriate, but I didn’t feel that I had been cared for. When I came back a week later for them to check on my progress, I was seen by a different doctor. The first thing he did when he came into the room was shake my hand. He asked me how I was, how I got injured, and what I was concerned about. While we talked, he came over and touched my shoulder, and asked me where it hurt. My diagnosis and treatment didn’t change, but the way I felt about it did. I had not just been cared for, but cared about.
As in every industry, the main topic of conversation in medicine today seems to be AI. And while the kinds of achievements large language models have made (or their companies promise they will make) assisting doctors, streamlining care, and helping patients advocate for themselves are impressive, I fear that with overzealous implementation, it will be just another tool that will take us further from each other. Right now medical AI is flawed: hallucinating diagnoses or suggesting unsupported treatments. It is still in its infancy, and there’s no doubt it will improve, and that we will get better at using it. In the future, it could even help eliminate the technological tedium that stands between doctor and patient. But while what we can do with this new, magical technology is exciting, I don’t think it should be what we are talking about most.
For too long our emphasis has been far from the people in our healthcare system and the relationships between them. I think patients feel less heard than ever. When we talk to a computer, we know it is not a person. When we talk to our providers, we get to know them; and when we know our provider, we trust them. We have a duty to rebuild the social relationship between providers and patients, not just as professionals, but as people.
As humans we are flawed; it is our fragility that unites us. When we go to urgent care, and the doctor puts their hand in ours, it is one fallible human touching another. AI, no matter how close it gets to simulating a human physician, will never feel the pain of a broken hip, or wake up with a sore throat. And it will never be a member of our communities, never be our neighbor or our friend, not really.
Created by: Seth Husney
