The Lost Art of Healing by Bernard Lown, MD and The Healing Touch: Keeping the Doctor-Patient Relationship Alive Under Managed Care by David L. Cram, MD

Author: 
Reviewed by Nathaniel S. Lehrman, MD
Article Type: 
Book Review
Issue: 
November/December 1998
Volume Number: 
3
Issue Number: 
6

These books, The Lost Art of Healing and The Healing Touch, discuss the nature and role of the patient-doctor relationship, the mounting administrative and organizational dangers to it, and how to address those dangers. The relationship itself, according to Dr. Kerr L. White, former deputy director for medical affairs of the Rockefeller Foundation, “seems to account for about half of the benefits associated with medical and other health professions’ ministrations.”

In The Lost Art of Healing, Dr. Lown, the renowned, privately-practicing cardiologist and Nobel prize winner as co-founder of the International Physicians for the Prevention of Nuclear War, sees “medicine’s profound crisis [as] deeper than economics. [Having] indulged in a Faustian bargain, medicine has lost its way, if not its soul. An unwritten covenant between doctor and patient, hallowed over several millennia, is being broken. The tradition that bonded doctor and patient in a special affinity of trust is being traded for a new type of relationship. Healing is replaced with treating, caring is supplanted by managing, and the art of listening is taken over by technological procedures. Doctors no longer minister to a distinctive person but concern themselves with fragmented, malfunctioning biological parts. The distressed human being is frequently absent from the transaction.”(1)

To him, “listening attentively,” which requires “engagement of all sensibilities, is the most powerful diagnostic device in the doctor’s armamentarium. A doctor who takes a careful history reaches a correct diagnosis in 70 percent of cases. This is far more efficient than all the currently available tests and technologies. The most cost-effective way to reach a diagnosis is for a doctor to become fully engaged with the total human presence.”(2)

The book’s first three sections — “hearing the patient: the art of diagnosis,” “healing the patient: the art of doctoring,” and “healing the patient: science” — brim with beautifully written clinical vignettes. Shorter sections follow on “incurable problems” (i.e., “caring for the elderly” and “death and dying”), “the rewards of doctoring,” and “the art of being a patient: getting doctors to listen.” Warning about the “managed care juggernaut” — “an industrial behemoth, which has shifted from attending the sick to guarding the economic bottom line, [thus] putting itself on a collision course with professional doctoring” — he points out that “giving precedence to profits [in this way] also makes for more expensive health care in the long run.”(3)

In directing his book to both patients and doctors, he describes the ideal physician as someone “with whom one feels comfortable in describing complaints without worrying about being subjected, as a result, to numerous procedures; for whom a patient is never a statistic; who does not recommend measures that compromise life in order to prolong life; who neither exaggerates the hazards of minor illnesses nor is overwhelmed by major ones; and [who is,] above all else, a fellow human being whose concern for patients is actuated by the joy of serving, regarding it as an incomparable privilege.”(4)

Dr. Cram, a distinguished dermatologist now retired from active practice, also presents “old-fashioned views on how to maintain a healthy patient-doctor relationship.” But his more expository book focuses on the specific problems in medical practice produced by managed care. After defining “bedside manner” and the “patient-doctor relationship” as together making up “the healing touch,” his book’s title, he presents four chapters on the bedside manner, followed by discussions of the dying patient, the changing role of nurses under managed care and some real life experiences, the book’s most interesting section. His last chapter focuses specifically on “other consequences of managed care”: the “diminishing quality of health care,” “diminishing morale among health care professionals,” “declining salaries,” “increased stress levels,” and the “increasing potential for litigation.” He concludes by addressing the need to control managed care companies, and suggests this be done through legislation. While managed care bureaucrats are loyal only to their own and their stockholders’ pockets, can the profession rely on government bureaucrats (and the legislation they administer), even though they are at least theoretically responsible to the citizenry?

Dr. Lown has played a central role in the establishment of an Ad Hoc Committee for the defense of Health Care — first in Massachusetts and then, he hopes, nationally. Dr. Cram lectures widely about the dangers to, and the importance of, preserving patient-doctor relationships. Unfortunately, neither of their books mentions the Association of American Physicians and Surgeons, the first organization to recognize the danger to those relationships from third party involvement — and especially from third party payers. Despite other differences, organizations like the AAPS should reach out to Drs. Lown and Cram to work together to preserve the patient-doctor relationships they agree are in jeopardy.

Reviewed by Nathaniel S. Lehrman, MD
Roslyn, NY

References

1. Lown, B. The Lost Art of Healing. Boston, MA, Houghton Mifflin, 1996, p.xi-xii.

2. Ibid., p. xiv.

3. Ibid., p. 320.

4. Ibid., p. 332.

Dr. Lehrman is retired clinical director of Kingsboro Psychiatric Center; former chairman, Task Force on Religion and Mental Health, Commission on Synagogue Relations, New York Federation of Jewish Philanthropies; chairman of the mental health committee of the Humanist Society of Metropolitan New York. His address is 10 Nob Hill, Roslyn, NY 11576.

 Originally published in the Medical Sentinel 1998;3(6):226-227. Copyright © 1998 Association of American Physicians and Surgeons (AAPS).

(The Lost Art of Healing by Bernard Lown, M.D., 332 pages, $24.95, ISBN: 0-395-82525-3, Houghton Mifflin, Boston, MA, 1996.)

 (The Healing Touch: Keeping the Doctor-Patient Relationship Alive Under Managed Care by David L. Cram, M.D., 116 pages, $9.95, ISBN:1-886039-31-3, Addicus Books, Omaha, NE, 1997.)

 

 

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