Humanity and Medicine

The seriously ill patient has entered another kingdom, an alternate universe, a place and a process that is frightening, infantilizing; that patient’s greatest need is both scientific state-of-the-art knowledge and genuine caring from another human being. Caring is expressed in listening, in the time-honored ritual of the skilled bedside exam — reading the body — in touching and looking at where it hurts and ultimately in localizing the disease for patients not on a screen, not on an image, not on a biopsy report, but on their bodies.

I recall an occasion when we were on rounds seeing a patient, and suddenly a vile odor filled the air. Time stood still until an earthy and wonderful nurse said: “Do you all smell poop? Let’s fix that!” and stepped forward, and we did, too, rolled up sleeves and learned from a master, with minimal fuss and minimal embarrassment to the patient, how to take care of something that a keyboard won’t do for you, what no algorithm will sanitize. Medicine is messy and complicated, because humans are messy and complicated. That is why I love it. And what all of us in the trenches — housekeepers, nurses, nursing assistants, therapists, doctors — have in common is that humanity. We came to this for many reasons, but it sobers me how many people came because they had a sense of calling, because they genuinely care.

So let’s not be shy about what we do and ought to do and must be allowed to do, about what our patients really need. As he was nearing death, Avedis Donabedian, a guru of health care metrics, was asked by an interviewer about the commercialization of health care. “The secret of quality,” he replied, “is love.”