The history of medicine has been a long history of ever-shrinking specialization. When we celebrate important breakthroughs in healing — the authorization of the COVID-19 vaccine or the first successful heart transplant — what we applaud is the ability of our researchers and doctors to zero in on a condition and provide treatments over and over again. the most efficient even for the most terrible of diseases.
However, we believe that we — health care professionals and researchers — have gone too far. If we want to fix our ailing health care system, our best hope is to rethink how we treat and heal our patients. We must rekindle the human connection and boldly reimagine the practice of medicine as a collaborative, relationship-minded enterprise, devoting significant resources to ensuring that patients see themselves as full partners in recovery.
Does that seem too ephemeral, too far removed from the strict prescriptive formula of saving lives?
These instances of one-sided care delivery increase far more frequently when patients are not privileged individuals with access to excellent resources, education, and care. Women, people of color, and immigrants with limited English proficiency are at greater risk of being misdiagnosed, underrecognized, and undertreated for many illnesses. This contributed to the massive 46% increase in the gap in life expectancy at birth between the US black and white population between 2019 and the first half of 2020.
It is clear that we have a systemic problem. Given that 80% of our well-being is determined by factors such as access to health care, the physical environment and lifestyle choices, we need to close this gap by rethinking how we invite patients — especially those who feel most disenfranchised — in conversation. We must 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 stuck with our team for years. As a young man, he had served in Vietnam as an army medic and happened to visit a Montagnard village where some people were in dire need of his services. However, when he tried to treat these sick villagers, Carmona noticed that they recoiled in disbelief. For several days he did nothing but live among the assemblers, 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 would prescribe penicillin pills to patients who needed them and then leave, promising to return a few weeks later. When he did, he was greeted with fanfare and given a precious gift: A necklace with all 40 penicillin pills he had left behind. The local leaders, firing back, told him they would place the necklace on the chest of sick patients, as their traditional approach to healing recommends.
For a while, Carmona regarded the story as one of failure — after all, he had limited success in educating Montagnard peasants in the workings and benefits of Western medicine. But he soon realized that there was a deeper, deeper moral to his story: he was welcomed and trusted by the villagers, he realized, not because he was able to show clear, efficient and demonstrable results, but because he had taken the time to show respect to them. He was there as a human being, connecting with other human beings, and this basic yet 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 provide more appropriate and effective care when care team members speak the patient’s language and understand their sensitivities. The same is true of community partnerships: With much of our overall health defined outside the narrow context of clinical care, redesigning the health care delivery model with a more holistic roadmap to include partnerships with non- -health, nationally and locally, can make a big difference in optimizing healthy behaviors and encouraging healthier lifestyle choices.
But the kind of radical empathy we need if we are to earn the trust of our patients and rethink the way we deliver care goes beyond sweeping organizational measures. To reform our health care system, the entire medical community will need to fundamentally rethink how we approach our work.
Imagine a medical school class that teaches potential doctors not only how to have good bedside manner, but also how to share their stories of hardship and loss, and how to open up about their 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, monetized process, but instead joined with empathy, compassion, and trust. Such an approach would fly in the face of hundreds of years of medical history — but we cannot afford not to take this turn.
With more Americans sicker than ever and with our current mode of healing no longer able to cope with the many public health crises, shortening life expectancy, it is time to review and reconsider. It’s time to rekindle the most powerful healing tool in our arsenal: human connection.
Jennifer Mieres, MD, is the chief diversity and inclusion officer at Northwell Health. Elizabeth McCulloch, PhD, is assistant vice president for Health Equity at the Northwell Center for Care Equity. They are co-authors of the book, Rekindling the Human Connection: A Pathway to Diversity, Equity, and Inclusion in Health Care.