What an old painting taught me about being present as a clinician
I I recently cleared out old files and came across a copy of The Doctor, a painting by Samuel Luke Fildes that hangs in the Tate Museum in London. The painting shows a doctor at a child’s bedside during a house call towards the end of the 19th century. If the child is in a crisis, the parents will look to the doctor while he is examining the child.
During my years as a pediatrician, this painting has crossed my desk and canvas many times. It is widely used in lectures and presentations to create feelings of nostalgia in the face of a changing health landscape. In other circumstances, it has been cited as evidence of the doctor’s tutelage that defined the doctor-patient relationship in the 20th century.
Whenever I saw a picture of the painting, I didn’t pay much attention to it. I didn’t find it remarkable or revealing. Just old.
This time, however, I couldn’t escape the drawing of the painting, although this time I couldn’t put my finger on what I found so convincing about the picture.
Then it hit me. It was the intensity of the doctor’s gaze and his demeanor. What caught me this time was his presence. This doctor was all in.
Presence is the mindfulness that brings one individual to an encounter with another. It is a defining element of human connection. In medicine, this is what happens when a clinician’s connection is not compromised by a screen or other competing input. It is the focus of mind, soul and intention in a moment when it comes to another person and their most pressing problem. Presence, whether in a clinic exam room or with a friend over coffee, is a unique human gift.
The scarcity of presence
Perhaps this time I noticed “The Doctor” because the presence at meetings in the healthcare sector is becoming increasingly rare.
Perhaps this portrayal of a patient encounter caught my attention because medical care is increasingly being conveyed through tools and instruments. Advances such as the electronic health record define the interaction between service providers and service recipients. And a lot of things that were previously done by doctors with eyes, ears and hands can now be done more efficiently using machines. Increasingly, the ability to physically connect with patients is being passed on to surrogate mothers. The cost of this technological presence is the segregation of patients and the progressive dehumanization of their encounters with doctors, nurses, and other health professionals.
Beyond technology, economic forces conspire to reduce human presence. This includes the industrialization of healthcare. This trend concerns the movement of patients through clinical spaces considering efficiency and profit margins. Industrialization has reduced the interactions between clinicians and patients to transaction units valued in terms of volume. Individual forms of person-to-person engagement are not recommended in favor of algorithmic checklists and script visits to improve survey metrics in the new home industry for patient satisfaction.
At the same time, medicine has become remarkably precise. Instead of looking at patients on a broader level like the doctor in Fildes’ painting, health professionals are trained to see collections of genes, markers, and proteins. By reducing the body to its most basic elements, we see diseases and their variants instead of people.
It has been suggested that “The Doctor” was created in response to concerns about the growing presence of science in medicine in the late 19th century. The lack of medical instruments in the painting was perhaps a subtle comment on the creeping technological divide between doctor and patient. There is nothing here that can break the intense bond between this doctor and the patient he is caring for. I can only guess that this was the artist’s point.
A new generation of superhuman clinicians
But times are changing. And most health professionals are unprepared for what the next generation of patients will need from them.
In his book “Deep Medicine”, doctor Eric Topol suggests that when artificial intelligence complements doctors’ daily work, emotional intelligence will be one of their most valuable skills.
That makes sense to me. When machines develop the ability to do things that humans once did, medical professionals need to master the things that only humans can do. This new clinical role requires the ability to translate and contextualize complex information in collaboration with patients. Presence and other fundamental elements of human connection will emerge as defining characteristics of a new generation of healers.
This reality will reshape the doctor-patient relationship and redefine the role of health professionals.
And ironically, the technology that separated healthcare professionals from patients at the dawn of the 21st century may force a new, unexpected role for us. Our inability to compete with machines can be exactly what sets us apart.
Driven by clinical complexities that only one human can explain to another, the future work of medical professionals will focus on an intense presence. And as technology continues its exponential march, expect a renaissance in human connection, as illustrated in “The Doctor”. I expect the human perspective to be reset when clinicians have to consider their purpose and mission as healers. One type of prioritization will bring health professionals closer to understanding where the technology sits between us and our patients. As a result, those charged with caring for patients learn to appreciate, cultivate, and focus on the very things that only they can do.
When human connection becomes scarce, the ability and willingness to connect becomes valuable and palpable – in paintings or in real life.
Bryan Vartabedian is the attending physician at Texas Children’s Hospital in Houston. He writes about medicine, technology and society in the 33charts newsletter.