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In the Hands of Doctors: Touch and Trust in Medical Care
Why is it that, despite the curative wonders of modern medicine, we still feel frustrated by doctors who lack the time and inclination really to care for us, much less care about us? In this book, Paul Stepansky explores this paradox through a historical examination of medical care that stretches back to the 19th century but focuses on the decades since the end of World War II. The reasons contemporary doctors find it difficult to care for their patients in the manner of the postwar generation are varied and range beyond the press of 15-minute office visits. They begin with medical education and its "hidden curriculum" and include the questionable manner in which medical educators approach the teaching of empathy. In the realm of practice, they include the disinclination of many primary care doctors to perform office procedures that put them in touch, literally, with their patients' bodies. And finally, there is social media, especially Facebook and patient satisfaction surveys, which have altered doctor-patient relationships in fundamental ways. Stepansky's comparative historical approach traverses a number of interrelated the role of procedural medicine in caring; the nature and goals of medical education; 19th-century approaches to cultivating caring doctors; and the changing meanings of friendship between doctor and patient. He explains the human dimension of medical technologies, old and new, and the different kinds of "touch" that enter into medical and nursing care. And then he brings his analysis to bear on the serious shortage of primary care physicians in the United States, considering along the way the rise and fall of the "family practice" specialty in America and the expanded role of nurse practitioners and physician assistants in primary care. Weaving into his discussion an astute appreciation of the Patient Protection and Affordable Care Act of 2010 and the new health care delivery systems it promotes, Stepansky concludes by offering innovative proposals for revitalizing primary care medicine and strengthening the trust between doctors and the patients who rely on them.
317 pages, Hardcover
Published May 23, 2016
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Displaying 1 - 2 of 2 reviews
August 14, 2016
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.
(This review was originally published at the Arnold P. Gold Foundation Research Institute blog.)
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.
(This review was originally published at the Arnold P. Gold Foundation Research Institute blog.)
April 24, 2017
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 Rae, APGF Health Communications Intern
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 Rae, APGF Health Communications Intern
Displaying 1 - 2 of 2 reviews