Article

Care

Comment

21 June 2023

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

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

Justice

Redemption

15 May 2025

4 min read

The case of Peter Sullivan proves once and for all why we shouldn’t bring back the death penalty

It’s not the wrongly convicted who are redeemed when justice is done - it’s all of us.

George Pitcher

George is a visiting fellow at the London School of Economics and an Anglican priest.

A court sits, with judges raised above the others.

The Court of Appeal.

Judiciary.uk.

The quashing of the conviction this week of Peter Sullivan, who served 38 years in jail for a murder he did not commit – along with the release in 2023 of Andrew Malkinson, cleared of rape after 17 years inside – are deeply shameful. They are revolting stains not only on our judiciary, but on all those who politically invigilate it and on the rest of us who elect them. We should all be deeply ashamed.

As we peep through our fingers at these terrible travesties of justice and the lives that have needlessly been wrecked, it’s natural to ask what we do next. In the absence of time travel, we can hardly make it up to Messrs Sullivan and Malkinson.

But we can grapple with what they mean to us for the immediate future. Probably the first and easist thing to say is – if I may not so much mix a metaphor as summarily execute it – that they should hammer legislatively the final nail in the coffin of the death penalty.

Sullivan would doubtless have swung for the murder of florist Diane Sindall in 1986 that he did not commit, if execution by hanging (or by other means) had not been abolished in 1965. True, rape hasn’t been a capital offence since 1841, when the penalty became transportation (which was almost as irreversible as death).

But Malkinson’s case rather makes the point: The very fact that he was still incarcerated meant that he could be released. Let’s take a case in which no such remedy was available – Derek Bentley, say, who was hanged in 1953 for allegedly abetting the murder of a police officer and exonerated, a trifle late, in 1998.

The arguments of thornproof and white-knuckled proponents of the death penalty may be as swiftly dispatched as they would wish such innocent victims to be. They were probably “wrong ‘uns” anyway. Their sacrifice would have discouraged others from committing heinous crimes. The taxpayer shouldn’t have to pay for their decades in the slammer. Well, pah. Try telling any of that to the Sullivan family.

But these are not, to my mind, the biggest issues and, enormous as they are, that must make the biggest pretty gargantuan. I wish to address the business of redemption.

But we can ransom the present to redeem our future.

Now, when I mention this word to those holding the pitchforks, prodding people they despise towards the scaffold, they usually assume I’ve come over all pious and priestly. And I suppose I have. But they invariably misunderstand what we mean by redemption.

The assumption is that the victim of the miscarriage of justice can be redeemed if they are still alive. Their life is in some way redeemed from suffering. That’s true, so far as it goes, but it’s not really what we should mean by redemption in these circumstances.

The Latin root of the word refers to the buying back, or the paying of the ransom, of a slave to enable his or her freedom. The ancient scriptural usage of the word relates often to the saving actions of the Hebrews’ God, in redeeming his people from slavery in Egypt, and to the Christian culmination of that redeeming work at the cross (totally uncoincidentally, both events are commemorated at the Jewish Passover, that first divine covenant being, in Christianity, fulfilled in the second).

The debate down the ages has substantially concentrated on to whom the ransom of that latter redemption was paid. For some, it was paid to a vengeful and wrathful God, for others to a somewhat gullible Satan, who took the bait of pay-off. Either way, a debt was paid which released humanity from bondage and slavery.

The theology of this can only be satisfactory to a proportion of people who read it, whether believers or not. The important matter is to whom the act of redemption is of value. A slave who died building a pyramid for a pharaoh doesn’t seem to have been redeemed in any more meaningful sense than the young Bentley being pardoned 45 years after he was hanged. Exoneration isn’t redemption.

In the Christian tradition, it’s significant that the compilers of the gospels and the books thereafter develop less the idea of ransom to explain the cross, than the idea of deliverance from bondage that was its result.

And there the answer, rather than the victims, hangs before us. We can’t redeem the injustice of the past, anymore than we can give Sullivan and Malkinson back their lost years. But we can ransom the present to redeem our future.

To those who claim that murderers and rapists “get off” because of “loopholes” in the law, we say there are no loopholes, only the law. And we’re all enriched when we get the law right. So, ultimately, it’s not the wrongly convicted who are redeemed when justice is done and they’re finally released. It’s all of us.