Richard Levin, M.D., says technology has transformed medicine, but the focus on technology and the value equation has caused us to lose the human touch. Can we use technology and still focus on empathy and compassion?
Announcer: Asking questions, seeking solutions. Algorithms for Innovation, live from Baltimore at AAMC 2015.
Albo: Hi, I'm Amy Albo. I'm here with Richard Levin, who is the President and CEO of the Arnold P. Gold Foundation. Thank you so much for being here with us. Can you tell us what you feel from your perspective is the thing in health care and medicine that most needs to change?
Levin: The understanding of the significance of the loss of compassion and empathy in the entire spectrum of health enterprises.
Albo: How do you see that manifesting—where do you see that?
Levin: In every health encounter—institutional, ambulatory care, it doesn't matter. The availability of technologies that actually make a difference in the course of an illness, and the acceptance by clinicians of the need to be efficient, to follow the value equation—which is value equals quality over dollars—has caused us to lose sight of the fact that this began and must remain a human interaction between clinician and patient.
Albo: From your perspective, how has technology become in the way of humanism in medicine?
Levin: Technology is actually neutral. It's neither a good nor bad thing. It's how it's used, and whether we're aware of its potential to move us way from the critical challenge, which is to reestablish contact. We began to lose it curiously, paradoxically with Laennec's invention of the stethoscope.
Before that, in order to listen to the wheezing of a person with asthma or the burbling of someone with pneumonia, you had to put your ear on the patient's chest. With the invention of the stethoscope, which amplified the sound, it moved the doctor away from the patient physically. In many ways, we've been on that pathway now for over 200 years.
Albo: So what do you think the harm is in moving the physician away from the patient?
Levin: So ultimately patients need to feel that they're in a safe harbor in order to be completely open, to be truthful, to be intimate, to be accepted by another human being whose soul purpose in being there is taking care of that individual. Research has shown that compassionate care improves health outcomes.
Albo: So what do we need to do if you had to choose one or two things to get beyond this and back to place of a more humanistic patient provider relationship?
Levin: We need to change the nature of health professions education so that the conversations about these very difficult, complex, basic problems in human existence can be understood before our students hit the first wall of transition, which is from studying biology to taking a pulse, meeting a patient, being in the hurly-burly world of the academic medical center. And [we need] to get the student involved to understand how strong the pull will be of what academics refer to as the hidden curriculum, the curriculum that is the process of being socialized into becoming a practicing physician.
And the second thing is an understanding by the top of the chain in what have become hospital city-states—remarkable organizations that have extraordinary power in local or huge geographies. There must be a recognition that in that value equation is this fundamental human value that will in fact result, not only in a better bottom line, but in the salvation of health care in the United States. And encouraging the conversation will allow us to move back to the future.
Albo: Are you hopeful about this new generation of health care providers?
Levin: I'm hopeful and frightened. I'm hopeful because touring around the entire country, interviewing medical students about this perspective humanism and medicine, they are as good, as turned on, as engaged, as hopeful, as any group of medical students in my lifetime. So that's fantastic. If anything the system is encouraging a group of people who could be humanist in practice.
The concern is that we have allowed a system to develop– and that's an active thing we did—which seems to fail to recognize the value of this most fundamental of the core elements of scientifically excellent practice. I think it will be fine, but we do need to go through this process of recovery.
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