A glimpse of the heart and soul of medicine

Patients and physicians once shared a strong and lasting bond of trust and genuine concern. Can we ever get back to that in our modern world?

During my first year of medical school, I shadowed a family physician in rural Maine. Little did I know at the time, but this would be one of very few glimpses I would see of a kind of physician-patient relationship that has been all but crushed by the sad realities of modern medicine.

26 January 2014

I recently had the privilege to shadow a family doctor here in Maine. Most of the general practitioners I have met seemed somewhat frazzled and discouraged by their workload. Many seemed to wish that they had specialized. What follows is the opening of my mind to an aspect of medicine I had not yet seen. The doctor’s name has been changed to protect his identity and the identities of his patients. Before I was ushered back into Dr. Moore’s office, I chatted with the people in the waiting room. One man, who looked to be near 70, was particularly engaging. As soon as he saw that I was a medical student, he asked if I knew the first rule of medicine. I responded, “Do no harm.” He asked if I knew it in Latin. At this point I began to suspect I was dealing with a former physician. We talked on, and it came out that he was the very man who trained Dr. Moore during residency. The first patient I saw with Dr. Moore was the older physician from the waiting room who had trained my preceptor. They discussed the practice of medicine and taught me to see some of the issues inherent in our medical system. As they ruminated over their experiences in family medicine, they concluded that after about 10 years of practice in the same place, you begin to understand the great gift that is a career in family medicine. The relationships you form with your patients in a small town setting after years of practice are priceless, and they are what make the job so profoundly rewarding. Throughout the rest of the day, I was shown what they meant. As Dr. Moore entered exam rooms, he greeted each patient with a familiarity that spoke of a long-standing relationship. As the conversation began, it was apparent that a patient’s visit with Dr. Moore never ends; it is merely on pause until the next check-up. This makes all the difference in the way he communicates with them. In medical school, we are taught to communicate with complete strangers. In order to obtain the full story quickly, we rely on valuable but rather stilted checklists. Dr. Moore already knew each patient, and he usually knew half of their family members, too. All he needed was an update since their last visit, which would elicit only patches of the SOAP note –and only patches were needed. Continuous care over the course of years allowed Dr. Moore to understand his patients’ problems with just a few simple questions, leaving him plenty of time to teach them about their problems and to counsel them on the solutions. One experience was particularly telling. An older Japanese lady who spoke no English came to see Dr. Moore with her middle-aged son. She was in a lot of pain, and she had no appetite. With her son translating, Dr. Moore asked her questions to clarify what was happening inside of her. He inquired whether her pain medications were working; her eyes welled with tears as she responded that they only provide superficial relief. She wondered if her weight loss and pain were prelude to her impending death, and she seemed almost to welcome the thought. Somewhat shaken, Dr. Moore immediately responded, “I’m not ready for that to happen. Are you?” He placed his hands on the table in front of him and sighed as he absorbed this new turn of events. For the rest of the day, Dr. Moore was different. Some of his prior joviality was gone, doubtless overshadowed by the experience just related. Nothing could have confirmed more definitely that this man cares for the people he serves. I have seen a side of medicine today that I never had considered. Is there anyone who has a better view of life than a family physician? They see the lives of hundreds of people unfold over the course of decades in the most intimate detail. They understand, and they serve. Perhaps only parenthood could compare.

My hope is that AI can relieve enough administrative and clerical burdens to allow patients and physicians to reconnect once again. This can only happen if we turn our focus away from maximizing appointment throughput and toward optimizing positive impact on patients as whole individuals. This has traditionally been more difficult to measure than the number of appointments, procedures, or prescriptions, but I am convinced that AI can help us gain a more holistic view of each patient and their outcomes.

Another area where I think we can make a difference is by using AI to tell the patient's story in a clear, concise way; a way that cuts through all the noise and highlights what is most important about the patient, and what is most important to the patient (see this article on how AI may someday understand human values).

What will happen to the patient-physician relationship in the era of AI? Tell us what you think in the comments below!