The Patient-Doctor Relationship is Failing. It is Time to Embrace the Human Inside Us.
If you have cancer, would you rather be taken care of by a human doctor or an AI doctor?
An ambitious study conducted in the UK recently claimed that artificial intelligence is far superior to physicians in diagnosing breast cancer from mammograms. In an era where modern medicine is revolutionized by the integration of artificial intelligence and computerized technologies, physicians find themselves in a rather complicated – if not undesirable – situation. We are not used to being second-in-command, as shown in the centuries-spanning history of medicine. In the 18th century, medical paternalism was the norm that formed the basis of a patient-doctor relationship. Physicians were these god-like figures who made all the decisions, leaving not much room for negotiation. The term patient was more linked with a set of diseases that a physician knew best rather than a fully-functional individual with a story to tell. Now, the rights of patients to autonomy and individualized care are getting more recognition, yet the authority of doctors around the world is still held with high regard. Meanwhile, artificial intelligence threatens to strip this very power away from doctors. Therefore, if machines have already proven to be better than doctors in diagnosing diseases and formulating treatment plan, what is the role of doctors in patient care?
Doctors are losing touch with their patients, quite literally. Medicine is considered by many a combination of both science and art. Although recent studies have shown that machines are able to outperform doctors in terms of hard skills and scientific knowledge, I believe that it is the artistic value of medicine that cannot be taken away from human doctors. The very basic definition of art refers to a particular skill acquired by experience and observation. Medical schools may slightly differ in their curriculum, but the average time spent by students in medical training around the world is similar: 8 to 10 years. It is during these years in which doctors drink countless cups of coffee, overdose themselves on medical journals, but most importantly, better their interpersonal skills. There are some ways which allow a doctor to get that touch back. Our role in medicine, after all, is not to compete with technology to prove which race is superior, but it is to provide the best care possible to all our patients.
The Art of Communicating
To highlight the importance of proper communication skills, let us hear it from the most crucial stakeholder in hospital: patients. An investigation into 23,658 medical malpractice suits between 2009 – 2013 by Crico Strategies showed that a great number of patients sued their doctors because of communication problems. This was reflected in a third of all cases. Examples of such communication problem include the following: a doctor failing to disclose all necessary information regarding a patient’s health, a doctor avoiding collaboration with the patient in providing care, and a doctor lacking empathy when discussing sensitive topics with a patient.
How are hospitals reacting to this? Not enough, apparently. Ask a person working in a hospital and you will most likely find that there are many rules, regulations, and treatment protocols that dictate how healthcare providers must act under diverse circumstances. There is a treatment protocol for anaphylactic shock, the use of different ‘codes’ indicating emergency situations like cardiac arrest, yet there is almost no directive on how doctors must break down a patient’s situation into words should there be any such case. Classes held by hospitals on effective communication for doctors have increasingly gained popularity in the United States and United Kingdom, but they are often trivialized and overlooked by less developed countries. We need to acknowledge that it is not the qualifications of a doctor that first come under patients’ scrutiny; it is how he or she simply talk with them.
Fortunately, medical schools are better than hospitals at responding to this obstacle. As a student in one of the most prestigious medical schools in Indonesia, I was taught valuable communication skills since the very first semester. Classes of empathy and role-playing are held every year up to our graduation. We have been taught how to discuss sensitive topics including religion and spirituality, perform history taking, respond appropriately to a patient’s question, break bad news, and become an active listener. Our lecturers, who are senior physicians themselves, repeatedly emphasize the importance of possessing this set of skills. Some give greater credit to medical students who are better at communicating than those who are merely capable of memorizing anatomy of the brain overnight. Last year, during an objective structured clinical examination (OSCE) where medical students are required to perform a set of procedures or practical skills, nearly 20 out of 60 students did not pass because they simply forgot to gather informed consent from the patients.
The Art of Touching
Medicine is supposed to be intimate. The relationship between a doctor and his or her patient should be intimate; this was the norm for centuries before modern medicine. Physicians in the early 19th century evaluated heartbeats and breathing sounds by putting their ears close to the patient’s body. Although the stethoscope, invented by French physician Rene Laennec in 1816, has offered clearer results on the basis of science, it marked the beginning of a deteriorating patient-doctor relationship. In fact, the instrument was created out of an awkward encounter; Laennec was too shy to get close to an overweight woman and felt that it was improper to touch her. Nevertheless, I believe that touch makes a doctor more like a fellow human being and less like a robotic healthcare machine. Perhaps, no other individual puts it better than internist Danielle Ofri in a piece from the New York Times:
“Touch [is] inherently humanizing, and for a doctor-patient relationship to have meaning beyond that of a business interaction, there needs to be trust – on both ends. As has been proved in newborn nurseries, and intuited by most doctors, nurses and patients, one of the most basic ways to establish trust is to touch.”
If it is so important, why are doctors so afraid of touching their patients nowadays? Has touch, one of the most basic human senses, been sexualized and associated only with harassment? Stereotyping & labelling by the public may be the culprit of this changing norm in medicine. Throughout recent years, there have been many cases in which doctors exploited their authority to sexually harass patients via inappropriate touch and gestures. Victims include both men and women of all ages, from children to the elderly. Thus, a mental picture which draws doctors as these irresponsible assaulters begun to form in the back of patients’ mind. However, while some gestures may be inappropriate and should be discouraged, touch in its true form has an inherent ability to heal and consolidate a patient-doctor relationship. When I perform physical examination on a patient, sometimes I still hesitate and feel awkward when touching his body to check for any lump or change in temperature. Yet, I am beginning to realize that touch is probably the single most important tool in medicine. In addition, machines don’t possess such privilege – only humans do.
All too often, I see articles here and there debating whether AI and machines will take over the medical field from human doctors. Are we going to surrender our jobs to them? This claim seems a bit too exaggerated at present time. I don’t know what the future of medicine holds, but I believe as healthcare providers we should focus more on current problems first. Why worry about tomorrow when we have greater things to deal with today? The relationship between patient and doctor is at its lowest point, and it is time to discuss it openly. Perhaps, doctors should take a break from reading those journals and put more effort in improving our communication and sense of intimacy with our fellow patients. Let us embrace the human inside us.
If you are a patient or have ever been one, please leave a comment below or share your thoughts with me at edwardchristopheryo@gmail.com.
