Demystifying Medicine One Month at a Time

Touchy Feely

Medicine sits at the vertex of art and science.

The tremendous success of molecular biology over the last three decades has fueled astonishing growth in Medicine’s scientific elements; often (though not always) this detracts from its more artistic renderings.

For some of us (doctors and patients) this is no doubt a good thing. We want our medicine based in science-it offers an exactness that we covet and a feeling that our actions, based on the best available evidence, are right.

For others, the increasing dominance of science has come at the expense of Medicine’s art. Not from direct competition per se, but more from benign neglect. With so much science and technology to learn about (dare I say master?), it’s not a big surprise that doctors struggle to learn the more artistic aspects of Medicine: compassion, empathy, communication, healing touch, and of course, uncertainty.

'Nuff said.

These aspects relate to emotion, never a strength in a data-driven culture.

A recent story in the New York Times explored how the field of psychiatry has almost completely shifted away from Freud and talk therapy toward psychopharmacology and efficiency. Upon reading it, I felt a sense of loss over the changes. Progress is never easy; people, places and ideas are inevitably left behind.

The story symbolizes for me that in our workaday world of medicine, there just isn’t much time or space for emotion. We want answers to our medical questions, without expressions of doubt, or at least as few as possible.

Yet emotion and medicine are laden with doubts:

  • Will I be OK?
  • What disease/condition do I have?
  • Can you help me understand and treat this pain?

The term “touchy-feely” is used pejoratively in most of Medicine. I often hear students and residents lament that certain classes or even whole specialties are “too touchy-feely.” This usually occurs with “messy” situations like birth, death, divorce, emotional trauma, substance abuse, mental illness, and chronic pain.

Problems like these don’t confine themselves to pat diagnoses or straightforward therapies. Nor do they get “solved,” if at all, in single episodes. Clinicians in broad fields like Family Medicine, Psychiatry, and both general Pediatrics and Internal Medicine contend with these types of issues on a daily basis.

It’s not a surprise that in a world valuing technology and clear answers over emotion, students choose fields that offer the promise of discrete and solvable problems.

“Touchy feely” may not be valued by those in medical training, but good doctoring requires it.

7 Comments

  1. Carolyn Thomas

    Thanks Dr. Schumann for this thought-provoking piece.

    But can’t we have BOTH instead of just one or the other? My longtime family doc once referred me to a specialist but (because she’s known me for 30+ years) warned me first: “You’ll hate this guy. He has zero personality – but he has a reputation as a very good diagnostician and if I were in your shoes, I’d want a doctor like him taking a look at me!” Nuff said. That was good enough for me. What I really needed then was good science. A personality would have been just gravy.

    As my friend Lynnie likes to say about those who are not ‘touchy-feely’: “You don’t have to go camping with them!”

    Trouble is, as a heart attack survivor with ongoing complications, and thus a frequent flyer with my cardiologist, family doc, medical consults, hospital trips, our Regional Pain Clinic, and an assortment of diagnostic labs, I have been seen by my fair share of those zero-personality types.

    Believe me, they can make an awkward, uncomfortable medical procedure 1,000 times worse for a frightened patient. And what many health care professionals may not grasp, for heart patients, there is NO such thing as a “routine” cardiac test.

    But I’ve also been the fortunate beneficiary of small moments – sometimes fleeting, of a doctor’s true kindness, a gentle word, a caring smile, an empathetic nod – that can soothe even the most overwhelming crisis for patients. Married with clinical skill, it’s an unbeatable combination.

    Cheers,
    C.

  2. Kelly

    It’s all about touchy feely, especially when we as patients feel so vulnerable. We need to have assurance when medically compromised.

  3. Michael Wong

    Great post — mere information is not enough; after all, look at all of the things that we know are good for us and don’t do (for example, exercise, eat more vegetables, etc). But, that’s the science.

    The “touchy feely” or, if you like, how the information is conveyed, is just as important — or perhaps even more important … because good science if not followed, is nothing.

  4. Carolyn Hastie

    Thanks for this post. You are raising incredibly important points here.

    We are emotional creatures. Emotions warn us, guide us, code learning, colour and flavour life. Emotions are the currency of the communication systems of the body. Medicine involves eliciting ‘buy in’ from the people you are caring for, using yourself therapeutically. Kindness, strength, gentleness, plus scientific, knowledgeable skilled practice is what works wonders. I’ve seen appalling and beautiful medical manners and I know how people emerge from those encounters. Those who communicate well, tell the truth, engage the people are truly gifts to humanity. Those who don’t are more likely to get sued. End of story.

  5. Jenn

    Well said. This post hit home. As a recent recipient of much medical care, I found the most skilled medical artisans I encountered were my nurses. While I was always thankful for my physicians’ medical expertise, I am now equally grateful for the observational assessments my illness provided. They are now influenceing my daily practice. I now lighten up to probe more deeply!

  6. Alex

    John,
    Fantastic post. I often wonder why docs speak of dealing with patients’ feelings so pejoratively. Is it because they don’t have time, given how long it takes to think about illness and apply all the fantastic technology we’ve developed to treat it, or do they simply feel inadequate and uncomfortable addressing messy emotions head on? In either case, it’s our (senior physicians’) fault. We haven’t role modeled and trained them properly.

    • glasshospital

      I agree with you–it’s both. Feelings are seen as “weak,” take too much time to explore, and bring up our own inadequacies. So on many fronts, it’s easy to put them in the pejorative category. I try to role model that (in my view) it’s what’s most important. I’m swimming upstream in that regard. Thanks for reading! -John

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