Kennedy: Doctors balance touch and technology

Kennedy: Doctors balance touch and technology

July 12th, 2018 by Mark Kennedy in Opinion Columns

Personal story: Our two sons, ages 16 and 11, are losing their lifelong pediatrician, Dr. Max Bryant, who is retiring later this summer.

I remember Dr. Bryant whispering words of comfort while he gently removed wood splinters from our older son's feet years ago when he was a toddler. More recently, Dr. Bryant negotiated with our finicky younger son to try one new food every week. Each boy has a paper medical file in Dr. Bryant's office as thick as one of those old Sears catalogs.

Mark Kennedy

Mark Kennedy

Photo by Staff File Photo /Times Free Press.

The boys have often paid Dr. Bryant the ultimate compliment: They actually beg to "go see Dr. Max" when they're feeling ill. They associate him with kindness. More than that, they trust him.

On our younger son's last visit, Dr. Bryant confided to me that these final weeks of practice are a bit difficult.

Apparently, a lot of the moms and dads, and even some of the kids, are taking his retirement pretty hard — some to the point of shedding tears during these goodbye visits. Knowing Dr. Bryant, I'm sure he finds these encounters humbling.

It makes me wonder: Will the doctors of tomorrow evoke such strong emotions from patients when they retire?

Several trends are converging to test the strength of the traditional doctor-patient bond.

» Telemedicine is creating convenience, yes, but also more distance between patient and doctor.

Erlanger hospital recently announced a new, $49 telemedicine service called Erlanger OnDemand that offers 24/7 teleconferencing with physicians for non-emergency services. Many people (including parents) will see this as a godsend, no doubt.

But it raises the question: How you remove splinters over the internet?

» Electronic medical records make patient care much more efficient. But some doctors are forced to spend more time with their hands on a computer keyboard now than wielding a stethoscope.

» Physician compensation systems that value procedures over consultations are pushing more young doctors into specialties. The result may be a shortage of primary care docs, who are the foundation — make that the beating heart — of our health care system.

It's good to know medical educators are taking note of the situation and looking for solutions.

July is the month new resident doctors and fellows arrive at the University of Tennessee College of Medicine-Chattanooga, a teaching partnership with Erlanger. A total of 63 new trainees arrived this month to funnel into the nine residency training and eight fellowship programs.

Dr. Mukta Panda, professor and assistant dean for medical student education, said these doctors-in-training will be coached and mentored not only on clinical matters, but on soft skills like empathy and compassion.

"The human connection [today] is challenged by technology," she observed.

For example, Dr. Panda said reviewing thousands of personal statements from aspiring medical students has taught her that most chose the profession because of a strong personal encounter with a doctor.

"It is that connection to other human beings which is the essence of why we become doctors," she said.

The advent of telemedicine has created an interesting issue, she said: "How do we balance touch and technology?"

Dr. R. Bruce Shack, professor and dean of the University of Tennessee Health Science Center, adds, "There's something to be said for what we used to call, 'the laying on of hands.' ... You can see from looking at a patient [in person], their anxiety level. If they are miserable, it shows through."

Telemedicine, Dr. Panda said, offers tremendous value but should not be used in isolation. Even Erlanger, in a news release about the OnDemand service, notes: "Erlanger OnDemand is not intended to replace your primary care provider."

To develop empathy, Dr. Panda has her resident physicians go through an exercise called "walking in a patient's shoes." Each student is given a case study and asked to think about how that real-life patient — given their living conditions — can follow through on a doctor's post-hospitalization instructions.

For example, a person who lives in a high-crime area may not be able to walk for exercise. Meanwhile, a patient with diabetes may not be able to change their diet because they live in a "food desert" with no high-quality fresh foods nearby.

Medical students in the UT system here meet periodically at Hunter Museum of American Art for a program that uses art to teach resiliency and diagnostic skills. Dr. Panda said one of the most important parts of physician training is learning self-care.

There are signs the program is working. Young doctors seem to want to come to Chattanooga, and the ones in the final two years of medical school training here want to stay.

That's the result of great clinical training, but also a validation of a program that values teaching emotional intelligence and resilience.

After all, at the end of a long medical career, tearful patients are a sweet and tender gift to those who listen to hearts for a living.

Contact Mark Kennedy at mkennedy@timesfreepress.com or 423-757-6645.

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