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

Character

Comment

Politics

Virtues

5 March 2025

5 min read

Are virtues irrelevant in today’s uncertain politics?

We need to exercise the character traits that uphold our values.

Emerson Csorba

Emerson Csorba works in deep tech, following experience in geopolitics and energy.

President Zelensky raises a hand while President Trump talks at him.

MSNBC.

In Oliver O'Donovan's Finding and Seeking, the theologian makes a telling comment about virtue, virtue referring to ‘the goodness the world has already seen and known…. Talk about virtue is always third person talk, observers’ talk about deeds that have already taken determinate form.’

Put differently, virtue is about the past. It is about how others have lived and acted in admirable ways. But it is not about today, in all of its ambiguity and uncertainty.

To put it directly – virtue falls apart when hit with reality. It is easy to talk about what virtuous people have done, much harder to be virtuous in the present. Or so O’Donovan says.

There has been a lot of talk over recent years about the need for virtues and values in politics (and in the world more widely), but what even are these things?

Values are principles or standards that individuals or societies consider important.

Virtues are moral excellences or traits of character, such as courage, patience, or humility.

Virtues are the moral character traits individuals need to uphold values, in practice.

When thinking about virtues and values, I often reflect on a simple but profound point made by Nigel Biggar speaking at Oxford University many years ago:

"If you want pure heroes, you won't have any."

Put differently, people – including the most virtuous at first glance – are complicated.

Yet, our world is one in which virtue seems to be in short supply. Some would even say virtue (and values) are non-existent, or on the verge of extinction.

The older I become, the more I am left reflecting on why it is that so few individuals – in political life, but also more generally – seem to live without principle. Integrity – which I define as ‘your word (or principle), and action aligning’ – seems increasingly a thing of the past.

Many seem to think that integrity is ‘old-fashioned,’ acting accordingly, saying one thing and doing another as if there are no repercussions.

This is replaced with an ‘anything goes’ mentality, focused on short-term gratification. It is a “you do you” culture, acting without conscience. People seem to believe there are few if any repercussions for doing bad things. This culture is not only permitted, but even celebrated.

The American situation is, of course, the example par excellence of this. American politicians and diplomats wake up each morning waiting for what their President will write on social media, responding accordingly. Alliances are thrown out the window. Nothing is off the table.

There is seemingly less interest in Western societies in being good persons, doing what is right in hard circumstances, and where few or no people are watching.

Whether in politics or in society more widely, people seem increasingly focused on protecting themselves, doing whatever they need to do to get ahead, rather than looking out for each other.

So where do we draw the line? Is there space for virtue (and values) in a world where growth is slowing, and more people are battling for parts of a shrinking pie?

I believe the answer is yes. My sense is that many people are today yearning for clarity of values and virtues in a world that is becoming much more anchorless.

There does then seem to be interest in values and virtues, but it is perhaps worth remembering that values and virtues are like muscles... It is possible to lose these muscles without practice.

In my home of Canada, where I recently moved back, many value decency, politeness, and a sense of moderation.

In 1955, while serving as Canada’s Secretary of State for External Affairs, Lester B Pearson put his figure on this pulse, delivering a series of lectures at Princeton University entitled Democracy in the World. Pearson argued that a sense of moderation is a leading value for Canadians.

He described this as a ‘confidence in the ability of the peoples and the leaders of democratic nations to grow into the new situations and to accept the greater self-discipline which the preservation of freedom in an interdependent world requires.’

And he saw Canada as especially emblematic of this ability to grow into new situations, this adaptability in working in an interdependent world.

Many Canadians believe that the thirteen provinces and territories need to adapt and work together in order to respond to the threat of the United States.

The candidate for Leader of the Liberal Party, Mark Carney, seems to agree (and is rising in the polls because of this), whereas his opponent Pierre Poilievre is moving in the opposite direction given his more combative approach. But Poilievre has time and the opportunity to turn this around, channeling Canadians' frustrations into a vision focused on the values and virtues we share in common.

In other words, Canadians value working together when faced with challenges, valuing this solidarity when times are tough. We become more courageous the tougher things become.

The virtue of courage is here a noteworthy virtue, so well proven in the Great War battles of Vimy Ridge, Passchendaele and The Somme, or the Battle of the Atlantic in World War Two.

We see this Canadian virtue emerge often in times of crisis.

Andrew Davison in previous writing in Seen & Unseen is especially eloquent on courage, writing that this virtue is:

‘both bracing and realistic. It reminds us that all is not well with the world. We will often need courage because doing the right thing can be costly.’

There does then seem to be interest in values and virtues, but it is perhaps worth remembering that values and virtues are like muscles – a point made by Carney in previous writing and speeches. And Poilievre, well-known for his considerable discipline, certainly understands the importance of the exertion that builds muscle."

It is possible to lose these muscles without practice. Over recent years, societies and individuals have become more permissive, rather than encouraging consistent exercise.

The question therefore is less about whether values or virtues will survive in the harsh light of reality. Instead, it is whether societies – their political representatives and citizens – are open to making the short-term investments necessary to uphold what they believe is good in their countries and in the world?

A tall task, to be sure, but one that I believe is both possible and necessary for Canadians and non-Canadians alike. Canada can here be an example for the world.

This task – upholding certain values and virtues, is not third person talk, as O’Donovan suggests. It is rather an imperative for action in the present. We are called to act accordingly today.