Making Medicine More Personal
A scene from the movie You’ve Got Mail finds Tom Hanks’ character, Joe Fox, trying to reconcile with Meg Ryan’s character, Kathleen Kelly, after putting her out of business, saying his decision wasn’t personal. Kelly conveys frustration at this sentiment, replying,
“What is so wrong with being personal anyway? Whatever else anything is, it ought to begin by being personal.”
If I had to describe medicine in one word, I would probably say communication: the external dialogue between a doctor and patient and the internal dialogue within a patient’s body. The importance of open communication between a doctor and patient as a way to both establish trust and gain information critical for an accurate diagnosis underscores the need for physician empathy. As Theodore Roosevelt once said,
“No one cares how much you know, until they know how much you care.”
Some may argue that physician empathy is irrelevant as long as a physician is properly diagnosing and treating patients, but physician empathy is not only important for maintaining doctors’ humanity and patients’ dignity but is key to medical efficacy. Patients of doctors who rate high on standard empathy scales have quicker recovery rates, better long-term outcomes, and fewer complications than patients of doctors who rate low on empathy.
Being a patient gave me an appreciation for the interconnectedness inherent in the human body. Intercellular communication is responsible for the smooth, successful functioning of bodily processes. It’s no surprise then that almost all pathology can be traced back to a failure to communicate. Cells can go deaf and fail to respond to certain chemicals such as insulin, as is the case in type 2 diabetes or they can go mute and fail to release insulin at all, as is the case in type 1 diabetes. Cells may misinterpret messages, send incorrect signals, or act at inappropriate times, all of which have pathogenic potential.
When I was diagnosed with anemia during my junior year of college, I had already been experiencing the myriad of symptoms associated with low iron stores for quite some time. Not only does iron play a key role in oxygen transport as a component of hemoglobin, it is also involved in a number of other metabolic processes, including dopamine receptor function, energy production, immune system function, nucleotide synthesis, electron transport, and cell proliferation and differentiation. Thus, iron deficiency can do much more harm than merely causing anemia; it can have widespread effects from damaging a person’s ability to think and concentrate to weakening one’s resistance to infection. As I later discovered, nutritional deficiency seldom exists in isolation and is usually symptomatic of a larger problem, such as intestinal inflammation or malabsorption. When one biomarker is thrown off balance, several processes are often simultaneously affected, as everything is naturally interconnected.
Herein lies the central tenet of medicine: integration. I have never been a proponent for the dichotomization of the “two cultures,” science and the humanities; rather, I see different fields existing along a continuous spectrum, intersecting, overlapping, and innovating. In the same way that the various disciplines compliment and learn from each other, so do various aspects of a patient’s history (genetics, demographics, environment, travel, attitude) factor into his/her well-being, underlining the need for a holistic approach to medicine. After all, health and healing come from the same root word hǣlan of Germanic origin, meaning wholeness. All too often, however, medicine is practiced in a compartmentalized, fragmented fashion without regard for how certain treatment affects the bigger picture, the body at large. A mechanic cannot fix a car without knowing how parts interact with other components; targeting symptoms in isolation, likewise, makes for ineffective medicine.
Of course, we still have much left to discover in this regard. Medicine still has its limits; cause and effect relationships are often unclear, diagnoses of exclusion are sometimes difficult to treat, and accurate prognoses are almost nonexistent. Ultimately, learning about a disease is incredibly different from living it out. In a textbook, a patient’s workup may seem swift and sequential; in reality, several weeks, months, or even years can pass from the time a pathology is first noted to the time a patient receives a diagnosis, and that time of uncertainty can be debilitating.
From a physician’s point of view, cultivating a sense of comfort with the fact that uncertainty is an inherent part of the practice of medicine and admitting what we don’t know can be difficult. Perhaps the only true certainty in medicine is that of our own mortality.
I leave you with these words from Charles Dickens’ character Estella in Great Expectations:
“Suffering has been stronger than all other teaching, and has taught me to understand what your heart used to be. I have been bent and broken, but — I hope — into a better shape.”
Suffering has taught me about the importance of communication, empathy, and integrative medicine. Being sick is draining, healing takes time, and a conversation can be just as important as a prescription.
