Opinion

Medicine’s new tools can’t replace compassion

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Genomics, digital technologies, telemedicine, avatars, precision medicine and now artificial intelligence are set to lead to a transformation in health care. Tools are being created that will accurately predict an individual’s risk of disease, thereby enabling the development of plans to allow people to mitigate their risk. If disease does occur, it will be treated precisely with targeted therapies. And mobile health technologies will bring care directly to patients via their smart phones, allowing care to be delivered anytime, anyplace.

The possibilities are breathtaking, but there’s another side to this story made obvious by a recent article in The New York Times. A hospitalized man and his family were dismayed to learn that further treatments for the patient were hopeless and that he had little time to live. A wrenching message under any circumstance, but having it delivered by a physician on video made it all the more unbearable and, understandably, the patient and the family were greatly distressed. As the patient’s wife said, “I just don’t think that critically ill patients should see a screen. It should be a human being with compassion.”

There’s an adage that virtually all physicians learn while training: “To cure when possible, to care always.” Yet the physician’s ability to deliver care with compassion has become more and more limited by an increasingly technical and bureaucratic delivery system that leaves little time for human interaction. Technology has clearly transformed the power of medicine to diagnose and treat disease more precisely, but the patient’s experience described in the article epitomizes the need for the medical profession to guard against the benefits of technology coming at the expense of caring and compassion. The very foundation of medicine is built on compassion -- the desire to relieve the suffering of others.

Technology must be continually advanced to improve care, but should never eliminate the compassionate bond between patients and their physician. Technologies that replace human interactions must be carefully judged against the need for, and value of, compassion, which provides not only deep benefit to both the patient and physician but is more cost-effective in many situations.

In a recent article I co-authored titled, “Compassion and Health Care: A Discussion with the Dalai Lama,” we contend that building a health care system founded on compassion will not only be more humane, but more cost-effective and rewarding for both the physician and patient. The Dalai Lama believes that compassion is ultimately the greatest source of joy on the part of the giver and recipient, a deep inborne emotion that leads one to become deeply engaged and committed to be involved with and care about others. It’s an inherent trait, but can be easily suppressed through lack of attention to it and by the stress of one’s environment that is frequently found in clinical settings.

Nonetheless, a focus on compassion is needed to attain the best outcomes for the prevention or treatment of many chronic diseases. Type 2 Diabetes, now a national epidemic, is an example. For effective care, the physician must engage with and understand their patient’s needs and capabilities in order to design treatment approaches that will be adhered to by the patient. To achieve best outcomes, patients need to engage in sometimes difficult behavioral changes that are best nurtured by their trusted and caring physician.

In my view, the lack of compassionate engagement between physicians and patients not only limits the satisfaction of both, it also fosters ineffective treatment of complex chronic diseases that account for almost 75 percent of health care expenditures. Maintaining the historic caring bond between physician and patient in our increasingly technical and fragmented health care system should be a basic tenet of medicine and among the highest priority for a more fulfilling and cost-effective practice of medicine. Technology is essential to increase curing, but can never replace the importance of caring.

Ralph Snyderman, MD, is chancellor emeritus at Duke University, and former CEO and president of the Duke University Health System.

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