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Digital
General Election 24
Politics
4 min read

Are we really our vote?

Elections exacerbates the worst of our digital personality.

Jamie is Vicar of St Michael's Chester Square, London.

A AI generaed montage shows two politicans back to back surrounded by like, share and angry icons.
The divide
Nick Jones/Midjourney.ai.

All the world’s a stage. Never more so than in a general election. Amidst the usual stunts and gimmicks of political leaders in election season (and much of the drama unintended or badly scripted) we too have become the performers. It doesn’t matter that Rishi and Keir are ‘boring’ - the digital space has created platforms for us also to posture and present our political positions. But in acting for the crowd, I worry that we’re losing a sense of who we are. 

If fame is the mask that eats the face of its wearer, then we’re all at risk of losing ourselves. Absurd! You might say, I’m not famous! But we have become mini celebrities to our tens and tens, if not hundreds or thousands of followers. Every post, story, or reel is an opportunity to project who we are and what we’re about, and what we think. Times columnist James Marriott goes so far as to write that ‘the root of our modern problem is the way opinion has become bound up with identity. In the absence of religious or community affiliations our opinions have become crucial to our sense of self.’ 

A recent study by New York University shows that many people in America are starting with politics as their basis for their identity. They say, "I'm a Democrat or a Republican first and foremost", and then shifting parts of their identity around like ethnicity and religion to suit their political identity. I’ve stopped being surprised when I see someone’s Twitter bio listing their ideology before anything else that might be core to their identity. But are we really our vote, or is there more to us than that? 

The platform is a precarious place to position yourself, as is the harsh glare of the smartphone blue light. 

If politics is the mask that we are presenting to the world, then we are engaging in a hollowing out of our representative democracy. Who needs an MP if we’re all directly involved? Don't get me wrong – I'm not in favour of apathy, inaction, or even lack of protest. But we elect members of parliament because we can’t all be directly engaged all of the time. Speaking all the time, about all of the things. Strong opinions used to be the possessions of those who had too much time on their hands… now you can be busy watch and pass on a meme in a matter of seconds without proper reflection and engagement. And so we’ve imported the very worst of student politics into our everyday digital lives and identities. 

Student politics is the often-formative, immature peacocking of ideologies one way or the other. It also often reduces others to caricatures, and the campus culture has increasingly become one that cancels rather than listens and illuminates. And so, the loudest voices dominate and intimidate others to comply. Someone I barely know recently sent me an invitation to reshare a strong opinion on social media. We’ve never spoken about this topic, and they have no idea if I've in fact developed an opinion on it. Marriott writes, ‘For many, an opinion has achieved the status of a positive moral duty… the implication: to reserve judgement is to sin.’ And without a merciful judge, sin means shame: not just what I do is bad, but who I am is bad too. 

The dopamine hit we get from these short bursts of antisocial media use is killing us. Martin Amis said that 'Being inoffensive, and being offended, are now the twin addictions of the culture.' That was 1996. Now engaging in politics in the era of the smartphone, we are addicted to the current age’s offended/being inoffensive dichotomy. Like the drug that it is, wrongly used, it will disfigure us as it propels us to play the roles the crowds want. The platform is a precarious place to position yourself, as is the harsh glare of the smartphone blue light.  

Every general election transforms the wooden floorboards of school halls into holy ground. 

Countless commentators have offered the wisdom that you are who you are when nobody’s watching. But we’re all watching, all the time. First, we had the Twitter election, then the Facebook election, and now political parties have recently launched accounts on TikTok (all the while wondering if they are going to try to ban it). What we need is a post-social media election. If the world is facing impending doom, then we don’t need doomscrolling to help. Whether it’s activism or slacktivism, our politics need not be our identity. We need a greater light source that reveals our truest selves, and helps us to be fully ourselves. This ‘audience of one’ is a much simpler, if not easier, way to live. 

After all, a secret ballot means nobody’s watching, and we don’t have to broadcast our vote, unless we really want to. On the 4th July, the ‘only poll that matters’ is private. We step out of the spotlights of our screens, and we cast a vote for the kind of leaders we want. Every general election transforms the wooden floorboards of school halls into holy ground. 

We’d do well to treat the online world as a sacred space too, and each person as a sacred person. Perhaps it’s time not only for a general election, but also a personal election: to step out of the spotlight, and the light of our phones, and quietly cast a vote for who we want to be. 

Article
Care
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5 min read

The healing touch in an era of personalised medicine

As data powers a revolution in personalised medicine, surgeon David Cranston asks if we are risk of dehumanising medicine?

David Cranston is emeritus Professor of Surgery at Oxford University. As well as publishing academically, he has has also authored books on John Radcliffe, and mentoring.

A doctor looks thoughtful will holding a stethoscope to their ears.
Photo by Nappy on Unsplash.

In 1877 Arthur Conan Doyle was sitting in one of Dr Joseph Bell’s outpatient clinics in Edinburgh as a medical student, when a lady came in with a child, carrying a small coat. Dr Bell asked her how the crossing of the Firth of Forth had been on the ferry that morning. Looking sightly askance she replied;  

 “Fine thank you sir.”  

 He then went on to ask what she had done with her younger child who came with her.  

Looking more astonished she said:   

“I left him with my aunt who lives in Edinburgh.   

Bell goes on to ask if she walked through the Botanic Gardens on the way to his clinic and if she still worked in the Linoleum factory and to both these questions she answered in the affirmative.  

Turning to the students he explained  

“I could tell from her accent that she came from across the Firth of Forth and the only way across is by the ferry. You noticed that she was carrying a coat which was obviously too small for the child she had with her, which suggested she had another younger child and had left him somewhere. The only place when you see the red mud that she has on her boots is in the Botanic Gardens  and the skin rash on her hands is typical of workers in the  Linoleum factory.   

It was this study of the diagnostic methods of Dr Joseph Bell led Conan Doyle to create the character of Sherlock Holmes.  

A hundred years later and I was young doctor. In 1977 there were no CT or MRI scanners. We were taught the importance of taking a detailed history and examination. Including the social history. We would recognise the RAF tie and the silver (silk producing) caterpillar badge on the lapel of a patient jacket.  We would ask him when he joined the caterpillar club and how many times he had had to bail out of his plane when he was shot down during the war – a life saved by a silk parachute. We would notice the North Devon accent in a lady and ask when she moved to Oxford.  

The patient’s history gave 70% of the diagnosis, examination another 20% and investigation the final 10%. Patients came with symptoms and the doctor made a presumptive diagnosis – often correct - which was confirmed by the investigations. Screening for disease in patients with no symptoms was in its infancy and diseases were diagnosed by talking to the patients and eliciting a clear history and doing a meticulous examination. No longer is that the case.     

At the close of my career, as a renal cancer surgeon, most people came in with a diagnosis already made on the basis of a CT scan, and often small kidney cancers were picked up incidentally with no symptoms. The time spent talking to patients was reduced. On one hand it means more patients can be seen but on the other the personal contact and empathy can be lost.  

Patients lying in in bed have sometimes been ignored. The consultant and the team standing around the foot of the patient’s bed discussing their cases amongst themselves. Or, once off the ward, speaking of the thyroid cancer in bed three or the colon cancer in bed two. Yet patients are people too with histories behind them and woe betide the medic, or indeed the government, who forgets that.  

With computer aided diagnosis, electronic patient records and more sophisticated investigation the patient can easily become even more remote. An object rather than a person.  

We speak today of more personalised medicine with every person having tailored treatment of the basis of whole genome sequencing and knowing each individual’s make up. But we need to be sure that this does not lead to less personalised medicine by forgetting the whole person, body mind and spirit.  

Post Covid, more consultations are done online or over the telephone -often with a doctor you do not know and have never met. Technology has tended to increase the distance between the doctor and patient. The mechanisation of scientific medicine is here to stay, but the patient may well feel that the doctor is more interested in her disease than in herself as a person. History taking and examination is less important in terms of diagnosis and remote medicine means that personal contact including examination and touch are removed.  

Touching has always been an important part of healing. Sir Peter Medawar, who won the Nobel prize for medicine sums it up well. He asks:  

‘What did doctors do with those many infections whose progress was rapid and whose outcome was usually lethal?   

He replies:  

'For one thing, they practised a little magic, dancing around the bedside, making smoke, chanting incomprehensibilities and touching the patient everywhere.? This touching was the real professional secret, never acknowledged as the central essential skill.'

Touch has been rated as the oldest and most effective act of healing.   

Touch can reduce pain, anxiety, and depression, and there are occasions when one can communicate far more through touch than in words, for there are times when no words are good enough or holy enough to minister to someone’s pain.   

Yet today touching any patient without clear permission can make people ill at ease and mistrustful and risk justified accusation. It is a tightrope many have to walk very carefully. In an age of whole-person care it is imperative that the right balance be struck. There’s an ancient story that illustrates the power of that human connection in the healing process. 

When a leper approached Jesus in desperation, Jesus did not simply offer a healing word from safe distance. he stretched out his hand and touched him. He felt deeply for lepers cut off from all human contact. He touched the untouchables.   

William Osler a Canadian physician who was one of the founding fathers of the Johns Hopkins Hospital in Baltimore, and ended up as Regius Professor of Medicine in Oxford,  said:  

“It is more important to know about the patient who has the disease than the disease that has the patient”.  

For all the advantages modern medicine has to offer, it is vital to find ways to retain that personal element of medicine. Patients are people too.