Review by Ali Rae
Where does the artistry of medicine really lie, and how can we cultivate it in today’s doctors? These seem to be the central questions of Paul E. Stepansky’s book, In the Hands of Doctors: Touch and Trust in Medical Care.
Dr. Stepansky employs the lens of a medical historian to examine the art of medical caring. The author traces historical truth as it relates to modern quandaries and uses that data, as well as personal narrative (his father, William Stepanksy MD, was a family physician who practiced in rural Pennsylvania) to project a vision for the future.
This book takes many conversations occurring in the world of medicine and reframes them in historical perspective. The result is a body of work with pearls of wisdoms strung between the pages. The passage below is representative of this unique approach:
“Critiques of depersonalized contemporary medicine from all sides and directions have long trained their sights on a common target: technology…By considering how physicians and patients reacted to the “high technology” of the past, we can understand that debates about the usefulness and desirability of medical technology are as old as medicine itself. EKG machines, X-ray machines, blood pressure meters (sphygmomanometers), hypodermic syringes, even the humble stethoscope—all were once high technologies that elicited deep ambivalence among physicians and anxiety and displeasure among the patients subjected to them…What were once newfangled instruments of questionable value have become aspects of personalized, technology-free doctoring…Over a span of years, they ceased to be alienating tools interposed between doctor and patient and became tools of a different kind, perhaps not tools at all but simple extenders of the physician’s person.” (pages 12 and 13)
The boldest parts of this book lie in Stepansky’s projections and recommendations for the future. As a scholar of the history of family practice and primary care in America, he makes thoughtful arguments for the greater integration of physician assisstants and nurse practitioners into primary care, as well as refocusing the methods of family physicians to a more hands on, procedural specialty.
Stepansky makes compelling arguments for the necessity of teaching empathy to medical students in a manner that is genuine, and not commodified. He addresses the question of friendship between doctor and patient, an interesting foray into a nuanced relationship. He also discusses burnout, offering a paradigm for understanding its origins and offering solutions to the problem of caregiver fatigue, with an emphasis on touch.
In the Hands of Doctors is an engaging and relevant read for anyone interested in the nuances of the doctor-patient relationship; a historical framework for understanding today’s questions in the medical humanities; or thoughtful narrative on cultivating humanity in the modern practice of medicine.
Ali I. Rae is in his fourth year of pursuing an MD/MPH at Brown and Columbia Universities respectively, with a concentration in Medical Humanities and Ethics. He writes poetry and fiction, as well as nonfiction on research topics with special interest in medical education, health policy, and the neurosciences. He serves as the Health Communications Fellow at the Arnold P. Gold Foundation Research Institute.