Article
Care
Comment
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. 

Article
Comment
Freedom of Belief
Politics
5 min read

No George, Christians aren’t free to worship in Iran

Apologists make a mockery of the real costs of freedom of belief.

Steve is news director of Article 18, a human rights organisation documenting Christian persecution in Iran.

A couple stand on the steps of a cathedral in Iran.
On location with George Galloway.

I guess it’s a good job he’s no longer a member of parliament, or George Galloway may be facing the same scrutiny Nigel Farage came under for his trips to the United States. 

It probably won’t surprise you to hear that the former MP for Rochdale didn’t head to the Land of the Free on his own extracurricular jaunt the other week, but instead to Tehran and Moscow.  

And no, George wasn’t there to remind Iran of its obligations to provide human rights for its citizens - as some might expect of a British MP - nor did he go to Russia to put pressure on Putin to end the war in Ukraine. 

No, George was simply visiting his comrades - distinct as they may be - and doing his bit for their distinct causes. 

Mr Galloway published two videos during his visit to Iran - both published on his X account - and both showing him standing outside the buildings of a recognised religious minority (meaning, in Iran, Jews, Zoroastrians and Assyrian or Armenian Christians. Not converts or Baha’is). 

In the first video, the man in the black hat is standing outside a synagogue in Tehran, which he tells his audience doesn’t even have a guard outside “because they don’t need one”, as the “millions” of Jews who live in Iran (actually there are less than 10,000) are so “honoured” and “cherished”. 

They even have their own members in the parliament, he tells us (actually it’s just the one), and “you didn’t know any of this, did you? Because they don’t want you to know.” 

Well, now you do.  

And, thanks again to the former Member for Rochdale, two days later you were also able to discover, much to your surprise, that Iran is also home to “so many Christian churches.” (For the record there are around 300, but none of them open to converts.) 

This time, Mr Galloway is speaking to you from outside an Armenian cathedral, still wearing the same outfit and therefore presumably recorded on the same day but published two days later - perhaps to give you enough time to digest your first lesson. 

Inside the cathedral, George assures us, there are “many worshippers quietly going about their religious obligations,” which is “quite different from the picture that is painted of Iran in Western countries,” don’t you think? 

And what would that picture be, eh, George? 

That Christians are routinely arrested and imprisoned for meeting together to worship, and in years past the leaders of their churches - including Armenians - were even murdered on those same Tehran streets on which you are now standing? 

But no matter, here at least is clear proof that one church in Iran is still functioning - as well as that synagogue; don’t forget the synagogue! - and as Mr Galloway proudly informed us 24 hours after his first video, nearly one million people (according to X it was closer to 50,000) had watched it. 

So, job done. Let’s not worry about the details. They take too much time to research, and can also trip one up when trying to make a point - especially regarding Iran’s treatment of religious minorities or, well, anyone really. 

But no matter, one can guarantee that most viewers won’t have bothered to look into it, nor scroll down far enough to reach the dissent. 

Now, I don’t know whether it was because George hadn’t quite lived up to his billing, but a few days later some “real journalists” arrived from the Grayzone website to add their own insights. 

The Brits had been told; now it was the turn of the Americans.  

“Americans may be surprised to know Christians exist in Iran and are allowed to practice their religion freely.” 

So wrote Grayzone News’ Anya Parimpil on X, alongside a post showing a short video from inside - wow, they actually let the Americans inside! - another Armenian cathedral, this time in Isfahan. 

And alongside a few more pictures of the church, Ms Parimpil posted some photographs of “ancient bibles” - no capital ‘B’ needed, it would seem, nor explanation that today in Iran Bibles are often used as evidence of a “crime” in court cases against Christians. 

Meanwhile, Ms Parimpil’s husband, Max Blumenthal, posted a long video interview with the Islamic Republic of Iran’s favourite interviewee, Mohammad Marandi, as they walked around a Tehran cemetery. 

You can watch it on YouTube if you like, but I wouldn’t recommend it; not only is it over an hour long, but in the wake of the axing of Stephen Sackur’s BBC news show HARDtalk, this one is more like an episode of SOFTtalk, in which the presenter asks only two questions of real interest - regarding the nuclear programme and popular support for the regime - to which there is never any danger of a follow-up probe. 

To paraphrase, Marandi’s answers were that the regime is wildly popular and well able to make a nuclear weapon if it wanted to but that it doesn’t because such things are “inhumane” and the Islamic Republic of Iran is, of course, renowned for its decency. 

Mr Blumenthal also posted videos of an Iranian man singing while embracing him underneath one of Isfahan’s famous bridges - with the message, “Iran is not your enemy” - and of the return of water to the local river, failing to mention, as one responder noted, that “due to the corruption and mismanagement of the horrific mullah regime, the river is basically dry all the time”. 

But no matter, one can guarantee that most viewers won’t have bothered to look into it, nor scroll down far enough to reach the dissent. 

Certainly, the overwhelming reaction to all the videos and photographs posted over the past week has been positive: essentially, a “thanks for showing us what Iran is really like and not only what the biased mainstream media (MSM!) says about it!” 

These are the days of SOFTtalk, it would appear, so I suppose we’d better get used to it. 

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