Medical Education Must Include the Human Touch

Breathtaking new treatments and mind-blowing technologies draw much of the attention when we consider ways to improve health care. This is not surprising as we are living at a wondrous time when machine learning and other advances may finally help us solve the riddles of cancer, heart disease and so many other scourges. At the end of the day, however, all of this progress hinges on the eternal foundation of medicine: the relationship between caregivers and patients.

As technology has enabled us to better understand the biological mechanisms inside our bodies, the medical community has become far more aware of the importance of improving this relationship by understanding the life experiences of patients that impact care.

This insight is now inspiring our efforts at the University of Michigan Medical School to refine our admission process and enhance our curriculum to help students become more sensitive to significant impacts health equity. It is unfortunate that such efforts, which are also occurring at medical schools across the country, have become politically divisive because they are an extension of the traditional mission of medicine – to identify and overcome the specific obstacles to care for every patient.

The students entering the medical profession today are not different from their predecessors in that all have a passion for improving health. What has changed is the recognition of the broad societal factors that influence health. Our students and our faculty are actively participating in helping us all chart this journey.

One of our recent reforms is to open these lines of communication to better achieve a fundamental goal of medicine – to create the necessary trust between doctors and patients so that we can identify all the factors at work. Knowing a patient’s medical history is not enough, we also need to know their personal history. As one of my medical school colleagues put it, we are trying to move from a system of treatment, to one of care by acknowledging not just the illness but the whole person.

This approach must define our relationship with every patient. It will not work, however, if we ignore the particular barriers and issues that contribute to disparities in health outcomes. And, if anything, the impact of disparities on health has worsened during the pandemic. We established working groups to analyze the varying patient outcomes across Michigan Medicine’s health care system – from our medical schools to our clinics and hospitals. They issued a series of reports with specific actions to address the problems and remove the barriers. While these recommendations involved a great amount of detail and nuance, what is most striking is how they dovetail with other reforms and new ways of thinking that have been reshaping our understanding of health care.

At bottom is the recognition that each patient is an individual, with their own unique genetic, biological and personal history. The decoding of the human genome, for example, has given us greater insight into why certain drugs may prove effective in some patients and not in others so that we can tailor treatments more precisely for each person. The medical community has also developed a greater appreciation for the many ways life circumstances shape the doctor/patient relationship. In general, physicians have tended to issue instructions – take this medicine, show up for this appointment – without inquiring how economic, transportation or other issues might hinder some patients from fulfilling them.

The challenge of addressing non-medical issues has long been overlooked. Factors such as: 1) the patient’s living conditions, mobility and safety issues, and possible environmental triggers for allergies or other conditions; 2) The patient’s adherence to medication, diet, and exercise regimens, and any barriers or challenges they face in following the doctor’s recommendations.

There are many, many examples of how we need to continually learn from our patients. Here’s one that really made a difference for me. In 1960 – two decades before I entered medicine – house calls were not infrequent. Over the intervening years, with rapid growth in diagnostic technologies, house calls almost ceased to exist which makes it harder to connect with patients.

I came to know an elderly woman who was cared for by an outstanding physician in a Federally Qualified Health Center (FQHC). She was remarkably healthy, but in recent months, her physician had noted she had lost weight, lost interest in life and her health was failing. Correctly diagnosing depression, he treated her with antidepressants but saw no improvement. It was the social worker assigned to this woman who reported the woman felt totally isolated. The cause? Her companion for over 15 years, a small, rescue shelter dog, had died. FQHCs have the flexibility to use their dollars in unique ways to improve health. The social worker came by and drove the woman to the local animal shelter. A month, and one adopted dog later, her health was on the rebound.

That’s an anecdote. Not everyone needs a new pet. But without engaging with this kindly woman in her home, her care providers would never have guessed her problem was isolation.

Now play that forward with the many societal challenges we face today: structural disparities including race and discrimination, including poverty and food insecurity … and many, many more.

All of our care providers, including our doctors of tomorrow need to understand these dynamics and their impact on health. Science has advanced health care tremendously and will continue to do so.

While the work we have undertaken is complex, our goal is simple: to train our students to become effective doctors by helping them become aware of the full range of factors that impact care, including race. This effort is an essential step in fulfilling medicine’s age-old mission of delivering the right treatment to the right patient at the right time.

Marschall S. Runge, former Executive Dean of the UNC School of Medicine, is Executive Vice President for Medical Affairs and Dean of the Medical School for the University of Michigan.