Article

Care

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21 June 2023

5 min read

The healing touch in an era of personalised medicine

As data powers a revolution in personalised medicine, surgeon David Cranston asks if we are risk of dehumanising medicine?

David Cranston

David Cranston is emeritus Professor of Surgery at Oxford University. As well as publishing academically, he has has also authored books on John Radcliffe, and mentoring.

A doctor looks thoughtful will holding a stethoscope to their ears.

Photo by Nappy on Unsplash.

In 1877 Arthur Conan Doyle was sitting in one of Dr Joseph Bell’s outpatient clinics in Edinburgh as a medical student, when a lady came in with a child, carrying a small coat. Dr Bell asked her how the crossing of the Firth of Forth had been on the ferry that morning. Looking sightly askance she replied;

“Fine thank you sir.”

He then went on to ask what she had done with her younger child who came with her.

Looking more astonished she said:

“I left him with my aunt who lives in Edinburgh.

Bell goes on to ask if she walked through the Botanic Gardens on the way to his clinic and if she still worked in the Linoleum factory and to both these questions she answered in the affirmative.

Turning to the students he explained

“I could tell from her accent that she came from across the Firth of Forth and the only way across is by the ferry. You noticed that she was carrying a coat which was obviously too small for the child she had with her, which suggested she had another younger child and had left him somewhere. The only place when you see the red mud that she has on her boots is in the Botanic Gardens and the skin rash on her hands is typical of workers in the Linoleum factory.

It was this study of the diagnostic methods of Dr Joseph Bell led Conan Doyle to create the character of Sherlock Holmes.

A hundred years later and I was young doctor. In 1977 there were no CT or MRI scanners. We were taught the importance of taking a detailed history and examination. Including the social history. We would recognise the RAF tie and the silver (silk producing) caterpillar badge on the lapel of a patient jacket. We would ask him when he joined the caterpillar club and how many times he had had to bail out of his plane when he was shot down during the war – a life saved by a silk parachute. We would notice the North Devon accent in a lady and ask when she moved to Oxford.

The patient’s history gave 70% of the diagnosis, examination another 20% and investigation the final 10%. Patients came with symptoms and the doctor made a presumptive diagnosis – often correct - which was confirmed by the investigations. Screening for disease in patients with no symptoms was in its infancy and diseases were diagnosed by talking to the patients and eliciting a clear history and doing a meticulous examination. No longer is that the case.

At the close of my career, as a renal cancer surgeon, most people came in with a diagnosis already made on the basis of a CT scan, and often small kidney cancers were picked up incidentally with no symptoms. The time spent talking to patients was reduced. On one hand it means more patients can be seen but on the other the personal contact and empathy can be lost.

Patients lying in in bed have sometimes been ignored. The consultant and the team standing around the foot of the patient’s bed discussing their cases amongst themselves. Or, once off the ward, speaking of the thyroid cancer in bed three or the colon cancer in bed two. Yet patients are people too with histories behind them and woe betide the medic, or indeed the government, who forgets that.

With computer aided diagnosis, electronic patient records and more sophisticated investigation the patient can easily become even more remote. An object rather than a person.

We speak today of more personalised medicine with every person having tailored treatment of the basis of whole genome sequencing and knowing each individual’s make up. But we need to be sure that this does not lead to less personalised medicine by forgetting the whole person, body mind and spirit.

Post Covid, more consultations are done online or over the telephone -often with a doctor you do not know and have never met. Technology has tended to increase the distance between the doctor and patient. The mechanisation of scientific medicine is here to stay, but the patient may well feel that the doctor is more interested in her disease than in herself as a person. History taking and examination is less important in terms of diagnosis and remote medicine means that personal contact including examination and touch are removed.

Touching has always been an important part of healing. Sir Peter Medawar, who won the Nobel prize for medicine sums it up well. He asks:

‘What did doctors do with those many infections whose progress was rapid and whose outcome was usually lethal?

He replies:

'For one thing, they practised a little magic, dancing around the bedside, making smoke, chanting incomprehensibilities and touching the patient everywhere.? This touching was the real professional secret, never acknowledged as the central essential skill.'

Touch has been rated as the oldest and most effective act of healing.

Touch can reduce pain, anxiety, and depression, and there are occasions when one can communicate far more through touch than in words, for there are times when no words are good enough or holy enough to minister to someone’s pain.

Yet today touching any patient without clear permission can make people ill at ease and mistrustful and risk justified accusation. It is a tightrope many have to walk very carefully. In an age of whole-person care it is imperative that the right balance be struck. There’s an ancient story that illustrates the power of that human connection in the healing process.

When a leper approached Jesus in desperation, Jesus did not simply offer a healing word from safe distance. he stretched out his hand and touched him. He felt deeply for lepers cut off from all human contact. He touched the untouchables.

William Osler a Canadian physician who was one of the founding fathers of the Johns Hopkins Hospital in Baltimore, and ended up as Regius Professor of Medicine in Oxford, said:

“It is more important to know about the patient who has the disease than the disease that has the patient”.

For all the advantages modern medicine has to offer, it is vital to find ways to retain that personal element of medicine. Patients are people too.

Review

Care

Community

Culture

Film & TV

25 March 2025

5 min read

Amandaland's portrayal of falling social standing is spot on

What happens when motherhood is no longer rich, powerful, and terrifying.

Beatrice Scudeler

Beatrice writes on literature, religion, the arts, and the family. Her published work can be found here.

On the sidelines of a pitch a well-dressed mum hands a coat to a sceptical looking mum beside her.

Nobody likes mums. Not really. We talk about our kids all the time, we’re bossy, we’re interfering, we’re no fun. The stereotypes abound. Not even mums like other mums. We should help each other, but we often end up mercilessly judging each other instead. If you work, you’re a cruel, neglectful mother; if you’re a stay-at-home mum, you’re lazy, weak, and probably boring.

Even worse than being disliked, though, is not being taken seriously. I thought motherhood would bestow a certain level of respect, a kind of admission, from society at large, that if you can keep a human being alive – let alone several – you must be somewhat competent at least. I can now see that’s only the case in older motherhood, once your children are grown up and you can prove to the world that you did, in fact, do a good job of raising them. Before then, while your kids are still loud toddlers or moody teenagers, being a mother is a decidedly low-status affair.

That’s exactly what Amandaland, the new Motherland spin-off, gets right. In Motherland, the original show, the character of Amanda is a confident, terrifying alpha mum, a modern anti-heroine and a foil to the frazzled, overwhelmed protagonist Julia. As a stay-at-home mum, Amanda holds on to her high social status by a combination of displaying her husband’s wealth and a careful strategy of putting other mothers down at every possible occasion.

By the end of Motherland, however, Amanda is lost: she opens and very quickly closes a lifestyle shop, she’s about to lose her house in the divorce, and her ex-husband is about to remarry. She’s not quite so terrifying anymore; she’s more human, more fragile. Her insecurities begin to show.

It’s only in Amandaland, however, that her alpha-mum persona fully breaks down. She’s had to downsize and – gasp – move from Acton to a less affluent part of London; her ex-husband is refusing to pay for their kids’ private school or for her car; she has no career and no prospects. While materially still more privileged than many, in the eyes of society she’s lost any claim to admiration.

As she meets a host of mums and dads from her kids’ new school after her move, it’s obvious that Amanda is trying to conceal this drastic change. She refers to all the furniture which she’s hording from her old, much bigger house – in her mother’s garage – as ‘curated items from my style archive’. When her mother nudges her to get rid of said ‘curated items’ in the school’s car boot sale, she deflects by declaring, in a suitably dramatic way, ‘I’m so ready to streamline all these investment pieces’. In the next episode she starts showing off, at her kids’ football practice, that ‘this big-shot interiors firm just begged me for a meet at their flagship store’. What she means is that she’s got a job interview at a kitchen and bathroom showroom. Which job she does get, by the way, and proceeds to refer to it for the rest of the show as her ‘collab’.

I said that nobody likes mums. I should have said, more accurately, that most people don’t find caregivers interesting.

There’s a reason Amanda speaks in cringeworthy euphemisms half of the time, and it’s not because she delights in being irritating. It’s because she’s feeling the full force of her fall in social status. We can judge her for being shallow enough to care about wealth and appearance so much. But it’s impossible for me not to feel an enormous amount of sympathy for her. I know what it’s like to see someone’s gaze at a social event drift away as you mention that you’re a stay-at-home mum. I know the agonizingly overnice look that often meets you when you say you’ve been trying to get back to work after having kids.

And to be clear, I’ve been referring to ‘mothers’ throughout, but consciously being perceived as low status is an experience common to all primary caregivers. In Motherland, Kevin, the stay-at-home dad of the group, was often mocked and dismissed as insignificant for looking after his two daughters full time. I said that nobody likes mums. I should have said, more accurately, that most people don’t find caregivers interesting.

There are two ways to respond to the plain fact that caregiving is seen as low status and low value, and Amanda learns both over the course of the show. The first is to realise we have an innate value that cannot be determined by social approval. We must become comfortable with being sneered at; there’s no way around it. Without spoiling what happens in later episodes, Amanda does grow in virtue by valuing status less and less, eventually rejecting the opportunity to return to wealth and high status for the sake of her family and her own integrity.

The second way is to find fellowship. The friendships which Amanda forms, especially with the wonderful Anne, also an original Motherland character, are what save her from herself in the end. Anne and the other parents show her that they, at least, don’t care that she’s no longer rich, powerful, and terrifying. They chip away at her armour until she realises that she doesn’t need to be adored in order to be loved.

We cannot control how people perceive us, but we can control how we respond. At the beginning of the show, Amanda’s response to the challenges of motherhood was to sink into self-absorption. In the end, she’s redeemed by the kindness of her friends. Motherhood will, perhaps, always be a thankless, low status job. But it’s also, and will always be, an irreplaceable one.

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