In fact, it never will be able to see you as you are. Though many of the dollar-driven decision makers within healthcare would have us believe otherwise, we can’t AI, blood-test or high-tech image our way out of our current US healthcare mess. As patients we are usually in some manifestation of pain or discomfort, are often uncertain, and even resentful because of those sensations. We are, in reality, a complex biopsychosocial species (see Dr. George L. Engel, 1977). Therefore, any insensate digital/numerical/visual representations of our suffering will always be a pale imitation of our lived reality.
Having spent 40 years as an emergency physician and 50+ years as a chronic autoimmune disease patient, I fully respect the necessity of all three of those tools. But most critically, we must acknowledge the proper roles of those as only supplemental tools. They can never substitute for a compassionate personal physician with a feeling heart and soul, who can be imitated by AI, but can never be virtually realized.
In the emergency department (ED), we physicians are more confident if your suffering manifests itself as a circumscribed purely biomechanical problem, for example as a shoulder dislocation, or even a complex biochemical disorder, like diabetic ketoacidosis. Both conditions are readily treatable, and are often quick glance doorway diagnoses, though are always confirmed by x-rays and blood tests respectively. Here the benefit of having primary care physicians able to expeditiously see their own patients can reduce our society’s reliance on the ED as a safety net substitute for a robust primary care system, which results in far less than ideal “waiting room medicine,” for those suffering from less clearly urgent conditions.
Alongside those readily perceptible and easily confirmable medical certainties though, lies an infinite variety of suffering that technology cannot even imagine or approach touching (the unavoidable reality of medical uncertainty). The range of human suffering is subject to our unique human combinations of frailties, stress responses, strengths and weakness and thus are actually, not virtually, limitless.
I believe that the monumental task confronting us as patients and physicians is to interact rationally and honestly, while overtly acknowledging the limitations of what we can and can’t know with certainty, and still contribute to the healing of illness and disease. If we fail to achieve that and continue on our current path, we are committing a form of slow-motion national healthcare suicide, as trust within the patient-physician relationship progressively erodes!
We currently find ourselves in the very midst of a concerted, dollar-driven, but poorly conceived, attempt to declare the patient-physician relationship dead and buried, in order to substitute the less effective and more expensive “consumer-provider” model. The “mess” created is one in which some of us get far more medical care than we need, while many more have trouble even accessing our healthcare system equitably. If you are one of the “haves” rather than the “have-nots,” you can elect to get a whole-body MRI for a mere $2500, just by requesting it, no doctor’s evaluation or order required!
My take-away here is that having the money to afford and the desire/anxiety to request high-tech testing is a poor substitute for guided medical advice from a personal physician who knows you well and by whom you feel known. In fact, multiple medical studies show that a more personal connection with a qualified primary care physician leads to lower healthcare costs for advice that you are more likely to follow through with, and by which you ultimately experience better health and a full halving of your mortality rate risk.
In choosing this personalized patient-physician relationship we can benefit from Engel’s insight that, “The boundaries between health and disease, between well and sick, are far from clear and never will be clear, for they are diffused by cultural, social, and psychological considerations. The traditional biomedical view, that biological indices are the ultimate criteria defining disease, leads to the present paradox that some people with positive laboratory findings are told that they are in need of treatment when in fact they are feeling quite well, while the others feeling sick are assured that they are well, that is, they have no ‘disease.”
New Jersey native and New Hampshire resident, Dr. Drew Remignanti, MD, MPH, author of The Healing Connection: A Partnership for Your Health (https://drewremignanti.pubsitepro.com/) writes from the dual perspective of a 40 year career emergency physician and of a 50 year career chronic autoimmune disease patient. He considers himself well educated by Dartmouth College, Rutgers Medical School, the Medical College of Wisconsin, as well as 15 hospitalizations, seven abdominal surgeries, and a major disabling stroke in 1992 at age 38. He wrote his book for the benefit of those of us who are involuntarily enduring medical suffering, as well as those who are voluntarily attempting to alleviate medical suffering in its myriad manifestations.
