The art of medicine: Hand on shoulder
Voltaire once said that “doctors put drugs of what they know little into bodies of which they know less for diseases of which they know nothing at all.”
I guess we could conclude that Voltaire was not a fan of physicians.
As you may know, Voltaire is the pen name under which French author/philosopher Francois-Marie Arouet published a number of books and pamphlets in the 18th century. He was a key figure in the European intellectual movement known as the Enlightenment.
In contrast, Hippocrates said “let food be thy medicine, and let thy medicine be food.” Almost 3,000 years after Hippocrates’ death, that fact has finally come to fruition
I bring up Voltaire and Hippocrates because I was reminded of the art of medicine, usually defined as how we apply evidence-based medicine to each and every patient we see. Of course, evidence-based guidelines are not written in stone, and we know each patient has to be treated as an individual, especially in the present era of personalized medicine.
However, the art of medicine goes beyond evidence-based information. There is the art of the physician-patient relationship and interaction.
For Voltaire, the art of medicine consisted of “amusing the patient while nature cures the disease.” Frankly, sometimes amusing the patient is helpful in difficult times during cancer treatment. Patients need to have confidence in their physicians, and physicians need to strengthen the relationship so that confidence is not lost.
Much of this in the oncology world is easier when the patient is physically present with the oncologist. Don’t get me wrong — there is no question that virtual visits brought about by COVID-19 have a role in oncology care. However, one surgical oncologist told me in the midst of COVID that he felt more comfortable looking into the eyes of his patient who was in his office to explain a complex surgical procedure and its potential complications vs. doing that virtually. There is also the physical hands-on interaction. As an example, a physician’s hand on the shoulder of a patient establishes that stronger bond between physician and patient.
This leads me to the other side of the coin, which is the topic of immersive technologies. Of course, the first thing one thinks about is virtual reality. In simple terms, virtual reality can be described as an artificial environment created with software and presented in a way that the user suspends belief and accepts it as a real environment. On a computer, virtual reality is primarily experienced through two of the five senses, sight and sound. However, immersive technologies have two other platforms. The first is augmented reality, which adds digital images to a live view, often by using the camera on a smartphone. Virtual reality, as opposed to augmented reality, implies a complete immersion experience that shuts out the physical world.
Lastly, there is mixed reality, a blend of physical and digital worlds unlocking natural and intuitive 3D human, computer and environment interactions. This new reality is based on advances in computer vision, graphic processing, display technologies, input systems and cloud computing. An example is Microsoft’s HoloLens, which is a holographic computer worn around the head with lenses over the user’s eyes that project holograms you can manipulate and interact with as though they existed in your physical surroundings.
I mention these immersive technologies because in the field of medicine, each of them can enhance teaching and learning. Although the physical hand on the shoulder between physician and patient is critical in the doctor-patient relationship, the immersive technologies will continue.
The bottom line is the physician-patient relationship truly depends on strong communication. Among providers, communication failure — not a lack of provider skill — has been noted as the root cause of about 80% of serious adverse events in the health care environment.
So, communication with immersive technologies is an option. However, through it all, we should not forget the Art of Medicine with hand on shoulder. Stay safe.
For more information:
Nicholas J. Petrelli, MD, FACS, is Bank of America endowed medical director of ChristianaCare’s Helen F. Graham Cancer Center & Research Institute and associate director of translational research at Wistar Cancer Institute. He also serves as Associate Editor of Surgical Oncology for HemOnc Today. He can be reached at npetrelli@christianacare.org.
Collapse
Read more about