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Care
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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 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. 

Article
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Politics
Trauma
War & peace
6 min read

So, what are the prospects for peace and good will?

2025 will need the reconcilers, and their pain.

Emerson writes on geopolitics. He is also a business executive and holds a doctorate in theology.

Two people down a table turn and listen to someone closer talk, against a wall mural.
Reconciliation event, Northern Ireland.
Telos Group.

As we approach 2025, a series of skirmishes are erupting that warn us of impending danger. In Syria, Turkish-backed rebel forces have overtaken Aleppo, taking advantage of Russia’s focus on Ukraine. Pro-Europe protestors in Georgia demonstrate at the country’s parliament in Tbilisi. And South Korea declares martial law in response to purported North Korean threats. President-elect Trump jokes – with much truth in jest – about Canada becoming the 51st state.  

As the world awaits the inauguration of President-elect Trump on January 20, 2025, we are in an in-between state. But there is more feeling of foreboding than of future peace. A ceasefire has been agreed between Israel and Hezbollah, but with rocket fire continuing to be exchanged and Israel yet to respond to Iran’s October missile barrage while Iran pursues nuclear capability. In the United States, Ambassador to Japan Rahm Emmanuel warns of Chinese ambitions to take Taiwan not in 2027 – as commonly believed – but rather in 2025.   

Even if only temporarily, there will be a pause in early 2025 from the conflicts we have been accustomed to over recent years. The inauguration of President-elected Trump will, in all likelihood, put an end to Russia’s war in Ukraine. Russian agreement for peace will be secured, however, only in exchange for Ukrainian territorial concessions. Israel will maintain a ceasefire with Hezbollah while American support helps to remove the remnants of Hamas in Gaza. With American backing, Israel and Saudi Arabia will restart the historic Abraham Accords process as we enter the Spring.  

Yet this pause and these short-term successes will be ephemeral and deceiving, an interlude prior to the much greater threats in store. Antonio Gramsci’s ‘The old world is dying, and the new world struggles to be born: now is the time of monsters” is often quoted with a tinge of optimism, as if the monsters are here for a moment, but soon to be overcome. Unfortunately, the monsters of our times are well-entrenched, and they are gathering energy for their next acts. And they appear from all sides, as the lesser rather than greater aspects of men and women take centre stage in our politics, whether in the political West or Global East. 

In this world of monsters, division and difference is the default approach to human relationships. We have become numb to these words, but what division and difference signify is a profound weakness in modern men and women bereft of love. Too many men and women prefer basking in their own and others’ flaws, to a striving to overcome these in favour of what we may individually and collectively achieve – if only we tried. We are living in a period of darkness seeking to dampen the light and diminish the spirit of those pursuing the good.  

Division is easy. It is natural. It is emotional. Its focus is the lowest element of ourselves and of others. In comparison, togetherness is faith. It sees the hidden potential of another. Togetherness is unnatural. Togetherness flows from faith and is the unseen-become-reality. It recognises the seeds of good in another, understanding that each person is composed of many contrasting sides, some bad, some good, but the good the more powerful of the two. Togetherness is a choice. It is a choice to water the seeds of faith with patience, to see what these seeds might become with time, consistency, and effort (while maintaining balance of personal space and social connections, as both are vital for emotional wellbeing). 

There is no bridging of divides, no reduction of division, no togetherness, without pain. This is a lesson for the world’s current and future reconcilers across all walks of life. 

In an age of growing division and conflict, togetherness is barely visible. Yet reconciliation remains possible. In fact, it is precisely in these times, when the odds are against the peace of togetherness, that reconcilers in politics, business, academic, non-profit and community sectors are called to step forward with purpose. It is precisely when there is little faith or hope in the future that reconciliation – an act of love – is demanded.  

Reconciliation is the restoration of a favourable relationship between oneself and others. It is achieved through sacrifice. The reconciler experiences pain in order to restore relationships. Reconciliation is built on love for other persons, in spite of their flaws and their continuous resistance, as well as their lack of faith, love and hope at many times. It requires a healthy self-love, in which we seek the fulfilment of our own good as a basis for doing so for others.  

Next to love, the main ingredient of reconciliation is pain, because those who have become estranged fight, they resist, they go back on what they said they would do, they vacillate between good and evil, and they contest the reconciler. The reconciler will die, or come close to dying, at certain points in the reconciliation process. And yet the reconciler is raised following death, defeat only a stepping-stone to the triumph of togetherness.  

The reconciler turns the pain involved in bringing together otherwise conflicting groups, peoples or nations into something much more positive. They internalise pain, incorporating it into their being. This is achieved through love, which enables patience, always seeing the bigger picture and the potential of people. Love is the basis for action to bring others together and keep them together, appealing to their better sides, despite the human tendency to corrupt the good. 

People talk nowadays about the need to ‘bridge divides’ and that we are ‘better together.’ We need, for instance, to bridge divides between regions and capitals, such as between Alberta and Canada, or Québec and Canada in the Canadian context, or between the North East and London, or with Northern Irish reconciliation, in the United Kingdom. But these are easy things to say. More difficult is realising that the process of reconciliation is painful and that leaders seeking reconciliation – at local, regional or national levels – must first become experienced in suffering.  

This experience can only be the result of a prior education in the value of pain, knowing that the joy of togetherness is most profound when preceded by a patient and humble suffering. There is no bridging of divides, no reduction of division, no togetherness, without pain. This is a lesson for the world’s current and future reconcilers across all walks of life, as we enter a world even more replete with conflict.  And in reconciliation, it is always unclear what the outcome is going to be. A person’s efforts could be all for naught, faithful efforts then a matter of failure and bitterness, rather than of sweet accomplishment.  

Anyone seeking reconciliation in a more dangerous world must first die to their previous lives of division. They must leave this self in the past, shedding it. They must become new persons, imbued with love, believing in human potential, who want others to succeed and who are ready to fight to achieve this success. But reconcilers must always fight with love as the foundation of their efforts, and with faith that they will win in their fight, that their efforts will be successful. This faith goes against what is seen – the odds are rarely if ever in reconcilers’ favour.  

We need reconcilers in our day and age. These individuals are in short supply, but they are key to the futures of nations and to the health of our geopolitics. They are the politicians - elected and those behind the scenes - the businesspeople, and the local community leaders who can see the bigger picture and articulate it, keep focused on the potential of those around them, and bear the suffering involved in fulfilling potential.  

The present wars and skirmishes as we enter 2025 will temporarily lessen. They will even pause. We should not be surprised when these re-emerge with more intensity over the next year. This is precisely when many will be called to strive for togetherness in the face of division, knowing that reconciliation is strength in the face of the reality of human weakness. Reconciliation is always a possibility. 

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