Harpham, Wendy S. MD
The conversation at the party began innocently enough. A woman shared her delight over the news of IBM's supercomputer “Watson” teaming up with Memorial Sloan-Kettering and Wellpoint. The woman, clearly intelligent and well-educated, happily insisted future patients will be better off entering their information into a computer that makes all medical diagnoses and treatment decisions. Before long, physicians will become technicians, and their compassion a sweet extra, like sprinkles on a cupcake.
WENDY S. HARPHAM, MD...Image Tools
Something's awry. She was inferring that it's okay for algorithms and sophisticated tools to squeeze out compassion from the modern doctor-patient relationship. Her cheery confidence bothers me. So much so that I'm compelled to play devil's advocate and question something I've always taken as a given. For my own sake, I need to explain to myself exactly why physicians' compassion is essential to high-quality modern medicine.
My reasons for this exercise extend beyond the public debate to the education of future generations of physicians. As my daughter awaits Match Day, she's wading knee-deep in risk stratification scores and evidence-based protocols. Don't worry: Throughout her four years of medical school, significant teaching time has been devoted to issues of compassion and medical ethics. Still, my reminding her why compassion matters may reinforce her commitment to devote herself to the art of medicine, as well as to the science.
To begin, I'll return to basics. Compassion is defined as sympathy for someone struck by misfortune, combined with a desire to relieve this person's suffering. Philosophers tell us that compassion is an emotion that lies at the heart of every life-enhancing relationship between two people.
What compassion looks like, though, depends on the relationship in which it arises. Your patients don't expect you to bring them a casserole or lovingly stroke their hair until they fall asleep. They'd freak out if, after lifting the bed sheet to examine a wound, you gasped or started crying. Rather, patients look to you for compassion—sympathy—that is controlled and informed, molded by years of professional training.
The culture in which compassion arises also shapes what it looks like. Back when doctors made house calls, few therapies in their black leather bag reliably altered the course of serious disease. So, after physicians made their diagnoses, their compassion—their emotional connection to patients—took center stage. Maybe they'd smile and squeeze a patient's hand reassuringly, if the prognosis was good. Maybe they'd shelter patients from distressing news of a poor prognosis, believing this the kindest, most caring approach.
Patient care was simpler then, especially compared with today's complex, technology-driven medicine where patients are cared for in clinics and hospitals by teams of doctors. Where patients Google their disease. Where shared decision-making is the norm.
Even with all these dramatic changes in medicine, physicians' old-fashioned expressions of compassion comfort patients. My physicians' reassurances calm my fears like nobody else's. At checkups, their asking about my writing fuels my sense of purpose, helping me find needed courage and fortitude through rough patches. Their end-of-visit handshakes and hugs help me feel whole.
While certainly healing, these measures have been secondary to the kind of compassion I've wanted and needed most from my physicians. If they truly care about me, Wendy, their emotional desire to help me fuels their efforts to determine exactly what's going on in my body, to guide me to wise treatment decisions, and to administer treatments as safely and comfortably as possible.
I suspect this might be where people like the woman at the party get tripped up when thinking about computers and compassion. They may not fully appreciate how physicians' compassion—physician's emotional sympathy for patients and desire to help—helps patients benefit optimally from advances in science and technology. You see, whether physicians are eliciting a history, reviewing test results or making treatment decisions, their personal connection with their patients shapes the dialogue in critical ways.
Sure, computers can generate questionnaires tailored for patients with specific symptoms. But they cannot tailor their language and tone to help patients overcome the emotional obstacles that often get in the way of giving accurate answers. They cannot detect the non-verbal cues that might tip off a physician that the patient misunderstood the question or is hiding something.
And, yes, computer software can spit out diagnoses and statistically favorable treatment options based on patient data. But machines cannot personalize their presentation of the facts in response to patients' level of understanding and readiness to hear the truth.
Let's take it a step further. Imagine counselors or patient navigators sitting beside patients at computer terminals, tenderly prompting useful answers to questions and framing the findings and recommendations with hope. Would physicians' compassion still be essential to high-quality care? Yes. Because determining the best treatment plan for a specific patient depends on both dispassionate facts and highly emotional factors.
Computers that retrieve and organize data with breathless efficiency cannot sensitively balance patients' personal values, risk-taking preferences and life priorities. They cannot meaningfully appreciate the impact of physical pain or lost income, or the grief that follows amputation or loss of function. Computers cannot understand hope or faith. They cannot care, so they cannot possibly determine the best treatment for individual patients.
As long as medical outcomes are uncertain, and as long as medical interventions cost money and cause toxicity, determining the best course of action for a patient remains a judgment call that depends on knowledge of this person as a unique individual.
Without compassion—without physicians' desire to learn what makes each person tick—heuristics and protocols may lead physicians to treatment that is “appropriate” but completely wrong for their patient. And as long as disease and injury cause pain and loss, the personal relationship between physicians helps patients choose wisely. This healing bond helps patients tame the fears and find the courage to live as fully as possible within the constraints of their illness.
Compassion matters as much today as it did in 1925 when Dr. Francis W. Peabody told a class of Harvard medical students, “The secret of the care of the patient is in caring for the patient.” In medicine, compassion must always matter. Because however science and technology change the face of patient care, the heart of healing must always lie deep within the physician-patient bond.
© 2013 Lippincott Williams & Wilkins, Inc.