The history of medicine is a long history of ever smaller specialization. When we celebrate remarkable breakthroughs in treatment – enabling the vaccine against COVID-19 or performing the first successful heart transplant – what we applaud is the ability of our researchers and doctors to focus on a single condition and provide increasingly effective treatments even for most frightening of diseases.
However, we believe that we – health professionals and researchers – have gone too far. If we are to fix our ailing health care system, our best hope is to rethink the way we treat and treat our patients. We need to rekindle the human connection and boldly reimagine the practice of medicine as a community and relationship-oriented endeavor, devoting significant resources to ensuring that patients are seen as full partners in treatment.
Do you think this is too ephemeral, too far from a rigid prescriptive formula for saving lives?
These instances of one-sided care delivery become much more common when patients are not privileged individuals with access to resources, education, and excellent care. Women, people of color, and immigrants with limited English proficiency are at greater risk of misdiagnosis, underrecognition, and undertreatment for many illnesses. This contributed to the huge 46% jump in the gap in life expectancy at birth between black and white US populations between 2019 and the first half of 2020.
We seem to have a systemic problem. Given that 80% of our well-being is determined by factors such as access to healthcare, physical environment and lifestyle choices, we need to close this gap by rethinking how we invite patients – especially those who feel most disadvantaged – in the conversation. We need to show them that their health is their most valuable asset and encourage their partnership as active participants in their health.
Richard Carmona, MD, MPH, former US Surgeon General, once told us a story that has stuck with our team for years. As a young man he served in Vietnam as an army medic and happened to visit a village in Montanar where several people were in dire need of his services. However, when he tried to treat these sick villagers, Carmona noticed that they retreated in disbelief. For several days he did nothing but live among the Montanars, listening to their stories, breaking bread with their leaders, and showing them that he wanted to know them and their way of life. Finally, after gaining their trust, Carmona was allowed to practice his craft, and the results were immediate and positive. He prescribes penicillin pills to patients who need them and then leaves, promising to return a few weeks later. When he did, he was greeted with fanfare and given a prized gift: a necklace with all 40 penicillin pills he had left behind. The local leaders, beaming, told him that they had placed the necklace on the chests of sick patients, as recommended by their traditional approach to healing.
For a while, Carmona considered the story a failure—after all, he had limited success in educating the Montagnard villagers about the workings and benefits of Western medicine. But he soon realized that there was a deeper, deeper moral in his story: he was welcomed and trusted by the villagers, he realized, not because he was able to show clear, effective and obvious results, but because he took the time show them respect. He was there as a human being, connecting with other human beings, and this basic but all-too-rare approach made the villagers trust him.
How can we apply these lessons to our practice today? One simple solution is to include a more diverse workforce. For example, health systems can offer more appropriate and effective care when members of the care team speak the patient’s language and understand the patient’s sensitivities. The same is true of community partnerships: Because so much of our overall health is determined outside the narrow context of clinical care, redesigning the health care delivery model with a more holistic roadmap that includes partnerships with non-health organizations nationally and local level, can make a big difference in optimizing health behaviors and encouraging healthier lifestyle choices.
But the kind of radical empathy we need if we’re going to earn the trust of our patients and redesign the way we deliver care goes far beyond large-scale organizational measures. To reform our health care system, the entire medical community will need to fundamentally rethink the way we approach our work.
Imagine a medical class that teaches future doctors not only how to have good bedside manner, but how to share their own stories of hardship and loss, and how to tell of their own failures and successes. Imagine medical education – and practice – focused on people meeting each other not as two nodes in a highly impersonal and complex, transactional and monetized process, but instead coming together with empathy, compassion and trust. Such an approach would defy hundreds of years of medical history – but we cannot afford not to take this turn.
With more Americans sicker than ever before and our current treatment regimen no longer able to meet the cascading public health crises reducing life expectancy, it’s time to step back and reassess. It’s time to reignite the most powerful healing tool in our arsenal: human connection.
Jennifer Mieres, Ph.D., is the Chief Diversity and Inclusion Officer for Northwell Health. Elizabeth McCulloch, PhD, is assistant vice president for health equity at the Northwell Center for Equity in Care. They co-authored the book, Reconnecting Humanity: A Path to Diversity, Equity, and Inclusion in Health Care.