Recently, I was amazed to see a small walk-in booth with a webcam, a monitor, and a curtain, offering telemedicine consults from the comfort of a service station on I-95. Pandora’s Box, I thought.
The robots are coming! Take a dip into popular science fiction if you don’t believe me. From Asimov to “Star Wars,” there are innumerable examples of aseptic, polite automatons providing prompt, unbiased, unfatigued medical care. People have always been enamored by such visions of the future. And booths like this are the gateway to that vision. As excited as I am about this tremendous advance and the potential it holds, I can’t help but feel that when this new frontier of medicine reaches fruition, we will have lost something, too.
Medical education is exacting, exciting, and at times, excruciating. But above all, the privileged experience of learning about the inner workings of the body is an innately human process. Looking back, it’s not syndromes, numbers, or dosages I remember, but the colorful spectrum of characters I encountered along the way. We’ve all met them – the funny, the quirky, the warm, the gentle, the stern, the phlegmatic, the intermittently explosive, the socially inept, the obliviously savant, and occasionally, the frankly sociopathic. They are the ones who teach us how the science of medicine connects with the art of healing. Our bedside manners and critical thinking processes are molded by the intercourse between the different types of personalities we encounter in our education.
Until the first Medibot 3000 is rolled out, doctors will be flawed, biased, and stressed humans. We deal with the same roller coaster journey through life as do our patients, but we accept a responsibility to be the caretakers of their health. Perhaps we do so not in spite of our faults, but all the better because of them. The human experience provides us with empathy. It ingrains within us unique insights and perspectives. It allows us to read between the lines of a patient’s statements. It pushes us to go beyond protocols when we need to, and it helps us create the trust that is the heart of the doctor-patient relationship.
Kintsugi is the Japanese art of fixing cracks along broken pottery with rare metals, thus creating unique and beautiful patterns which accentuate the character of the pot. It is part of a philosophy called wabi-sabi, which is all about embracing imperfection. I think they’re on to something there.
Patients are not vignettes. There is no peer-reviewed algorithm for being a good doctor. Not to say that these things are not important. They are crucial tools in our endeavor to improve our medical skills and knowledge – the bedrock upon which a career in medicine must be founded. But I hope that in our quest to improve outcomes, to remove suffering, and move toward the beckoning future, we still will have a place in medicine for human characteristics that define the act of healing, and for the philosophy of wabi-sabi. Bring the robots on, I say.
Dr. Behere was a pediatric resident at the Children’s Hospital at Dartmouth, Lebanon, New Hampshire, when he wrote this article. He is currently a first-year fellow in pediatric cardiology at the Nemours Cardiac Center at the Nemours/Alfred I. duPont Hospital for Children, Wilmington, Del. E-mail him at firstname.lastname@example.org.