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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
Economics
Politics
Trust
5 min read

Tariffs destroy trust so where do we go next?

Blunt weapons cause a mess in markets and lives.

Paul Valler is an executive coach and mentor. He is a former chair of the London Institute for Contemporary Christianity.

A gold coin with the DOGE dog on it, lies over the face on a $50 bill.
So doge-y.
Kanchanara on Unsplash

‘When America sneezes the rest of the world catches a cold’ quipped economists almost a century ago after the Wall Street crash.  A comment that might equally apply to the more than 10 per cent drop in stock markets caused by President Trump’s sudden raised tariffs on imports to the USA.  The impact of the American economy on the world is inescapable.  It represents almost a quarter of global GDP and the dollar is the leading reserve currency, accounting for around 60 per cent of international foreign exchange reserves.  Size is what enables America to bully the rest of the world. 

For decades the American trade deficit has been an elephant in the room and Trump is to be applauded for recognising it and addressing the problem. Unfortunately, the way he has gone about it has caused another, bigger problem. Changing the direction of the global economy is like turning a tanker, it cannot be done easily or quickly, but Trump’s style is to attack, like hammering at a nail.  Every issue in geopolitics looks like another nail, waiting for him to hammer out a negotiated deal.  Full marks for courage, but not for wisdom. The blunt weapon of trade tariffs is designed to bring wealth and power back towards the USA, but blunt weapons often cause a mess, and sure enough a global mess is what we now have.  A US/China trade war with higher prices that could end up stoking inflation and a government own goal.   

Panic selling of government bonds signalling a loss of confidence following Trump’s dramatic tariff boost is reminiscent of the impact of Liz Truss’ sudden and radical UK tax cuts, which were also driven by an ideology, but ended up as a wrecking ball.  Even some of Trump’s backers have warned of an economic nuclear winter.  In the long run, Trump has done the world a favour by highlighting a structural issue that needed correction, but his economically violent methods of addressing it look increasingly unwise.  If a global depression does happen on the back of all this, then coupled with the rise of autocratic and belligerent leadership, we would face a worrying parallel to what happened in the 1930s when the world eventually slid into war.   

Tariffs are like walls, barriers to cooperation and the epitome of economic selfishness.  Make America Great Again is selfishness writ large - a society pursuing wealth and power without the cohesive framework of values that are so essential to cooperation and community wellbeing.  A psychology of self-centredness that damages relationships at the national level.  This is what I find most concerning about Trump’s approach; not just the economics but the long-term legacy of relational damage that could last well beyond his Presidential term. 

Our fears reveal just how much we trust in wealth above everything else, and how much the fear of scarcity affects our mental health.

Michael Schluter in his book The Relational Lens defines five principles, or measures, of relational health.  They are directness, parity, common purpose, continuity and breadth.  Applying those five measures helps us see why Trump’s tariffs are the polar opposite of relational.  He introduced these escalating penalties remotely and not in face-to-face negotiations.  Exploiting the power of America instead of showing respect for the status and needs of other nations.  Tariffs have no common purpose with other countries, only a selfish agenda.  There is no continuity with previous trading protocols.  And it is all purely financial, with no reference to the broader holistic impact.  All in all, a relational disaster.   

Despite living in the ‘first world’ we remain gripped with fear of loss.  Our fears reveal just how much we trust in wealth above everything else, and how much the fear of scarcity affects our mental health. Markets are not entirely rational; they are driven by algorithms that stem from this psychology of greed and fear.  Emotions and trading swing wildly with a herd instinct that often drives behaviour.  As Rabbi Jonathan Sachs said:  

‘Markets have no moral compass; we have outsourced morality to legislation by the State.’   

But the worry now is that the current US administration shows signs of ignoring morality and even riding roughshod over the courts.  No wonder people feel afraid. 

Where can we find hope in all this turmoil?  Is there a better response than gritted teeth and the mantra: ‘this too shall pass’?  I think so.  There is life beyond the market.  Jesus said: ‘life does not consist in an abundance of possessions.’  We can choose to step back and look at all this with the true perspective that money isn’t everything.  We can cultivate gratitude for what we do have.  We can learn contentment.  Yet I feel for those who have experienced financial loss, and don’t want to minimise the reality of hardship.  In fact, something important and practical all of us who are privileged can and should do is to be vigilant in watching out for those who are poor and disadvantaged.  To look after those with a real need for the basics of life and help them through this tough time when economic disruption could make life even harder.  For those with a faith this is part of working out how our faith makes a positive difference where we are. 

Perhaps the supreme irony of this crisis is President Trump’s insistence that Americans must trust him.  Ironic, because the one thing that his tariff actions seem to have undermined more than anything else is trust.  The trust that is essential to the functioning of both markets and civilisation as a whole.  Face to face discussions must be the way forward now, to rebuild trust and find more nuanced, mutual approaches to solving America’s trade deficit.   

There is one person we can always trust though, and his name is written clearly on the American One Dollar bill. In God we trust. Let’s pray that Trump and his America returns to that imperative and turns back to a more Christ centred philosophy of loving our neighbour as ourselves, reflected in a more bilateral approach to diplomacy and agreement.

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