The power of preserving the healing touch of medicine

Through powerful personal anecdotes, Dr. Collins illustrates the importance of not only leveraging the amazing amount of medical data available to us but also ensuring that doctors of the future honor the irreplaceable value of the healing human touch.

As chancellor of the University of Massachusetts Medical School and senior VP for health sciences there, Dr. Michael F. Collins provides strategic management to a burgeoning UMass Medical School enterprise, which includes 1,200 students, a workforce of 6,000 employees and a thriving and internationally renowned biomedical research enterprise. Previously, Dr. Collins was Chancellor of the University of Massachusetts Boston and he served as president and chief executive officer of Caritas Christi Health Care System. He is a graduate of the College of Holy Cross and Tufts University School of Medicine.

This talk was given at a TEDx event using the TED conference format but independently organized by a local community. Learn more at https://www.ted.com/tedx

Medicine's future
must preserve its noble past.

You see, the heart and soul of medicine

finds its expression

through the caring hands

of those whose privilege it is
to look after others.

And as one who has the responsibility

to steward the education of those
who'll become behind me in my profession,

it's important that we remember
those principles.

Now, let me let you in on a little secret.

In second grade,
I had a crush on my teacher.

(Laughter)

She announced to the class one day
that she was going to get married.

And I was heartbroken.

(Laughter)

So I decided that I would do
a little report,

a report to try to get her attention

and to let her know
that I had a future as a physician.

(Laughter)

And here, in a Time magazine article

that appeared towards the end
of my second grade,

there was a story about an arthritic hand

and how doctors were able to -

through a procedure
where they released the constrictions -

able to put the hand back into a form
where it was once again usable.

And my little book report -

I can still remember it
in black paper with silver ink -

I turned in to my teacher, and said,

"You may be marrying this other guy,
but I'm going to be a doctor."

(Laughter)

Many years later, during medical school,

I had the privilege for the first time
to walk into the anatomy lab.

And there I met

my first, and among my best, teachers.

This woman had donated her body

so that my anatomy lab partners and I
could learn the structures of the body,

the anatomical findings
that you would have

to learn that there were
206 bones in the body.

And in that moment that I met our donor,

I can remember back to that report.

And I held her hand
with the greatest of esteem.

And shortly thereafter,
when we dissected the hand,

I remember hands intertwined with hands.

In fact, it was a bit difficult to discern
which was the hand of our cadaver

because our hands are so alike.

Yet that profound moment

of recognizing a covenant that exists

between those who care for patients
and the patients of the covenant

is that the hands of others
will be in the hands of their caregivers.

And then there was the epiphany.

One day, those hands would be mine.

Fast forward to today.

There's great concern in our profession
about the wave of data and information

that all clinicians must utilize
in their care for patients.

There's concern

that artificial intelligence
and technological developments

and new treatment modalities

will actually come, come between
the caregivers and their patients -

make it more difficult
to hold their hands.

Now, let's just think
about this for a minute.

Think about the phone in your hand
or the watch on your wrist

or the glasses on your eyes.

Today, those devices record what we eat.

By touching them, we can know
what our pulse and our blood pressure is.

We can assess our blood sugar.

We can schedule and have an appointment,

and every now and then, we can make
a phone call or check the time.

(Laughter)

And if you think that this
can't happen to medicine,

just think for a moment about banks.

When was the last time
you went to a bank?

But when you need money,

you can take your card,
go to a machine, put it in,

and out will come your money.

Think about your airline number;
most of you know your airline numbers.

Think about your hotel,
your hotel loyalty numbers;

you know those as well.

It wasn't until just recently

that you could know
your medical record number.

Now, let's think about it in the future.

When you utilize your phone -
just that passive experience -

by holding it to your head,

we'll be able to know your temperature,

know your pulse,
assess your blood pressure

and do so many other things
that we can't even envision today,

and that information will go directly
to your medical record.

Think for a moment about
the daily experience in the bathroom.

By sitting down,

almost immediately, we'll be able
to know the temperature of your body,

the weight,

the electrolyte makeup of your urine

and whether or not blood exists
in your urine or your stool

and whether or not it's necessary for you
to have a cystoscopy or a colonoscopy -

all before you flush.

(Laughter)

Now, this torrent
of information is before us,

and in fact,

there is great concern now
in our profession

about the amount of data

and how we can analyze it and utilize it
to make things better for patients.

Think about another moment,

think about playing doctor.

I can remember when I played doctor
the first time with my brothers.

I wore my father's white shirt,

I had a little plastic stethoscope,

a little hammer and a fake mirror.

And I held my brother's hand,

and I took my stethoscope
and I put it on his heart,

and I gave him a good rap of the knee

with my hammer,

watched his reflex.

It wasn't too different than Rockwell

when he depicted the doctor

and had the doctor

actually using the stethoscope to listen
to the little girl's dolly's heartbeat.

You know how children play doctor today?

They sit with their back
to their little friend,

they hold a computer,

they say, "What brought you in today?"

And as the child talks,
they start to type.

I can tell from the reaction
that you've been there.

(Laughter)

In many instances, I've sat in
on patient visits with their clinician,

and I wonder

about whether it is the patient
or the computer that we're caring for.

In fact, we're trained
to care for patients.

We're trained that
the doctor-patient relationship

is what's most important to us.

But now, we focus on
the doctor-computer relationship.

Now, think about it for the moment.

Who are the students in this picture?

To American medical schools today,

we admit humans,

and these humans will have
the responsibility to care for others.

But it's a very complex time in medicine.

Are you aware that each day in America,

a doctor commits suicide?

Are you aware to the extent
that clinician burnout

is causing us to lose
a legion of professionals

on a monthly basis?

Are you aware that 40% of women,

six years after their training
has concluded,

will reduce their practice hours

or leave the profession?

40%.

Now,

the data that we have,

the therapeutic possibilities
that have been discovered,

the treatment regiments
that we can utilize today -

these are outstanding.

The face of medicine
has changed for the better.

But we must now think and return -
think about and return to

the importance of
the doctor-patient relationship.

Sir Henry Tate, in the late 1890s,

asked Sir Luke Fildes

to paint an idealized picture
of the doctor-patient relationship.

Here is that painting.

You'll see a child
outstretched on a chair.

The child is thought to be
Sir Luke's one-year-old son

who had died a few years earlier
from tuberculosis.

The doctor's name was Murray,

but the face depicted
on the doctor in this painting

is thought to be
that of Sir Luke himself.

Many people missed the background,

where the mother and father are anguished
over the illness of their child.

All that existed was
the caring relationship

between doctor and patient.

There is no computer.

Honestly, there's no medicine;
there's no X-ray machine.

There's certainly no biologics,

because in those days
there was nothing to treat tuberculosis,

which is why the child died.

But what there is,

is a caring relationship that exists
between doctor and patient.

Now, as we look to the future

and all the wonderful things
that are occurring in medicine,

it feels to me like it's important

that we bring together
the caring relationship

with the new biologics, diagnostics

and technological regiments that exist.

It will only be through
that humanistic approach

that we can once again
revitalize our profession

and again bring to our patients

that caring relationship
that they so desperately want.

Think about the humanism that exists

when a caregiver promotes
their patient's human dignity.

Think about the humanism that exists

that when a patient faces fear,

their clinician will hold their hand.

Think about the final moments
of a person's life,

when all therapeutic possibility
has been exhausted,

when there are no more
treatments to provide,

when all is left is time for caring.

Think about in those moments,

if those who care for us
will take the time to hold our hand.

And when I talk with our students
about their futures in medicine,

I reflect with them about the hands
I've held throughout my career.

I remember holding the hand of a neonate:

my outstretched finger
and their grasp of it.

But as I held that baby's hand,

what was as poignant

was that my arm was around the parents,

who were shaking

because the love of their life
might not make it.

I can remember holding
the hand of a young girl

whose outstretched hand
on the soccer field

had been kicked by an opponent.

And a few hours later,
as we sat in the emergency room,

while her cast was being applied,

she turned to me and said,

"Doc, what's this cast going
to look like tomorrow night

when I'm in my prom dress?"

I remember holding the hand
of an early-twenties young man

who had been involved
in a motor vehicle accident,

in a car going at a high rate of speed,

and as I held his hand
in the emergency room,

he said to me,

"Doc, I'm going to die, Doc.

Don't let me die, Doc."

And a few moments later,

I brought his parents in to say goodbye.

They held his hand for the final time.

I remember holding the hand of a patient

the first time I made
a diagnosis of breast cancer,

the first time I made
a diagnosis of HIV infection,

the first time I made
a diagnosis of dementia.

And I remember caring
for a titan of business,

a man who, in a million years,

would never have thought
that at the end of his life,

I would be there to hold his hand.

But as I did,

I knew that I brought comfort to him
at this incredible moment.

Now, I often wonder

when it might be
that someone will hold my hand.

Will it be when a grandchild is sick?

Will it be when they hold the hand
of one of my children or of my wife?

Perhaps if might be
when they hold my hand.

I wonder if I'll remember

who it is that holds my hand.

Perhaps it will be when it's my hand
at the anatomy table.

But in that moment,

I hope my caregiver
will realize the privilege it is

to care for me.

And in so doing, recognize

that the future of medicine
can be assured

if we preserve its noble past.

I want you to know
it was a privilege for me

to have the opportunity
to share these thoughts with you.

(Applause)