What’s missing in today’s medicine? — Danielle Ofri’s N.Y. Times article is a springboard for reflection:
When I was a child, doctors still came to the house when someone was ill armed with a black bag containing (in my memory) only a stethoscope, tongue depressers, and a thermometer.
And armed, if you’ll forgive the unintended pun, with their own two hands. The doctor came, he (there were very few women doctors in those days) sat down at your bedside, took your hand in his, felt your pulse. He listened to your back and your chest with the stethoscope, felt your neck.
Whether or not you felt better right then, you felt a sense of confidence that you were in good hands (pun also unintended) and that you would be getting better. This was fortunate, as that black bag, until after the Second World War, contained no serious medicine, not even sulfanilamide, let alone the powerful antibiotics of today. The healing power of touch was of vital importance in those days.
Well, no one suggests returning to the bad old days of aspirin and iodine and silver nitrate, and not much else. But has a precious baby been jettisoned with the bathwater? Maybe.
Danielle Ofri, MD., New York City internist, writes in “Not on the Doctor’s Checklist, but Touch Matters”:
“Despite the inroads of evidence-based medicine, MRI’s, angiograms and PET scanners, there is clearly something special, perhaps even healing, about touch. There is a warmth of connection that supersedes anything intellectual, and that connection goes both ways in the doctor-patient relationship.”
Dr. Ofri describes all the procedures she uses to examine a middle-aged woman on an initial visit, leading up tothe physical examination, which she has left for last.
“As I examine her abdomen, we continue to talk, but there is a perceptible shift in the tenor of our interaction. The polite but businesslike nature of our initial conversation has melted. No matter how we’ve come to this room, to these postures, to this connection, we are now more intimate.”
Her article is a strongly written account of the laying on of hands which “sets medical practitioners apart from their counterparts in the business world.” Or used to.
Books from some of today’s ablest physician-writers: Dr. Ofri herself, Jerome Groopman, Lisa Sanders, warn about an alarming decline in doctors’ skills at physical examination. Causes range from the misguided: narrow medical education based on machinery and medication and regarding physical touch as insignificant compared with the serious stuff; to the villainy (often unmentioned) of managed health care. In focusing on time as money, insurance companies have in effect declared that the laying on of hands is worthless. (After all, where’s the money to be made by it?) Consequently many physicians often find their patients’ appointments limited to fifteen minutes. And physical examination, like so many other things of importance, takes time.
When I was a child, and for all the decades of my life since, I thought of doctors as holding a privileged position. They have the potential and the mission to heal their fellow humans, and they carry it in many ways, in their knowledge, their white coats, their emblematic stethoscopes, and above all, in their hands. In their very presence. I have never changed my mind about that — But it seems that much of the medical world has.
Yes, we’ve gained immeasurably in medical matters since I was a child. But what have we lost?
Doctors out there? Patients? Anyone? Your thoughts?