What gets measured gets managed, and what gets managed is given meaning.
For background, I practice medicine as a medical oncologist. This means I treat cancer patients in an inpatient and outpatient setting. I started this essay with a paraphrase of the famous Peter Drucker quote. It’s been on my mind of late.
There’s been a discussion online about when, if ever, healthcare should return to its pre-COVID norm, including asking at what point can doctors and patients meet each other unmasked. This essay is not meant to say that we have, necessarily, reached that point. But it is intended to emphatically call for that return to be our goal.
I was seeing patients in clinic recently, and I noticed how my own behavior has been altered. The facility where I work sends surveys after each visit, and one question is “did your provider wash their hands on entry into your room.” Our staff decided that, in the hand gel era, this can be interpreted as “did your doctor or nurse visibly slather a bunch of alcohol foam on their hands as they walked in the door?”
And that is not, by itself, a bad thing. No one in healthcare wants to be a vector for disease transmission, and there’s proven benefit to good hand hygiene in many situations, such as on hospital wards. But in order to satisfy a survey, I was walking into an exam room and, very first thing, covering my hands with gel. This might have a small effect on infection rates, but I can tell you what else it does affect: handshakes.
Yes, I know, those horrible disease-laden vectors that the COVID era banished. But I’m going to make the case that handshakes matter.
More broadly, physical human contact matters. It’s harder to measure, because it’s always contextual. A survey question of “did your doctor put her hand on your shoulder when she saw you were struggling” is not feasible. But that doesn’t mean such a gesture could not be incredibly important for both the doctor and the patient.
To turn the Drucker saying on its head, don’t confuse the measurable with the meaningful.
Because every intervention has consequences. Those can be explicit, like side effects from a vaccine, or implicit, such as how limited resources get deployed. Often, the negative effects are hard to measure, or appear much further down the road. We are starting to see the horrific impact that school closure and distance learning have had on student attendance and educational attainment. We are still in the early stages of assessing how masking and other forms of social distancing impacted language and social development. There’s a new epidemic growing, but this time in behavioral health; we need an honest accounting of how anxiety and isolation caused by our policy contributed to this.
Counting the number of COVID cases mattered, but I believe we became overly focused on what we could measure, not enough on these later and more subtle complications. I call this phenomenon the “other side of the scoreboard.” I hope to unpack some of these thoughts in future writing.
But for now, back to human touch in medicine.
I thought about making this a more technical piece, giving you a sense of the science behind human contact in healthcare. The research about hormones which affect bonding and get released with touch, or the anthropology about how we evolved as a social species. But others have done that. Those links could have been chosen from any number of other examples.
I’m not going to try to prove my case to you. I have 30 years of experience in patient care. In this essay, I’m asking you to take my word for it.
A shake for introduction. A hug at a reunion or for celebration. A squeeze on the shoulder after bad news. A hand, held, after a talk about going on hospice. None of these are likely to show up on any post-visit survey.
But they matter.
So do smiles. And frowns. Clear communication is foundational, but it has nuances that are impossible to quantify. It turns out that we all read lips, a little bit, and that we rely on this more than we realize as we age or hearing fades. “Did your doctor repeat himself loudly enough to be understood through the mask” is another one that isn’t on any questionnaire, but probably should be.
When you take a step back from COVID, you can see other forces that are squeezing the humanism out of medicine. Shorter visits. An electronic health record that splits attention and eye contact away from the patient. Multiple surveys that, no matter how well-intentioned, are no substitute for conversation.
As we come out of the pandemic, I am therefore asking those on both sides of the stethoscope to push back. Do not accept forever-masking as the new normal. The bond between doctor or nurse and patient in healthcare is ancient and intimate. It is profoundly human. It requires some of the messiness that comes with human touch. Don’t forget that faces matter. Remember that touch heals.
And even if I can’t exactly measure it, two people, united in our human frailty, holding hands in the face of mortality, is a source of some of the most profound meaning you will ever come across. Hold on to each other. We’re in this together.
Cheers, y’all.
David
(I have another essay that is more about oncology, if you are interested.)
Thank you for sharing these thoughts, David. I wholeheartedly agree with everything you've said!
Yes to the human touch! Also yes to quotation versus QUOTE because I'm sticking with the head in the sand