A brief summary of the Lecture delivered on 13 November in the University of Bristol
THE HUMAN SIDE OF MEDICINE
Professor Sir Denis Pereira Gray
OBE, MA, ILTM, HonDSc, FRCP, HonFRCPI, FRCGP, HonFFPHM , HonFIHSM FMedSci
St Leonard?s Medical Practice, Exeter; Immediate Past Chairman, Academy of Medical Royal Colleges
I would like to thank you Mr President and the Bristol Medico-Chirurgical Society for inviting me to deliver the 2002 Long Fox Lecture. It is a great honour and I am conscious of the many distinguished lecturers whom I follow.
It is a particular pleasure to see so many colleagues here tonight from both the worlds of the university and postgraduate medical education.
Edward Long Fox was a distinguished Physician on the staff of the BRI. He delivered the 1872 Bradshaw Lecture for the Royal College of Physicians of London and in 1875 developed the content into his book The Influence of the Sympathetic on Disease. I have been able to obtain a copy of it and I would like now to present it to you, Paul, to thank you and this Society.
Tonight I wish to consider a subject which I believe is as important to us today as the sympathetic system was to Long Fox.
The twentieth century was a time of dramatic developments in science , including many new investigations, new drugs, and new operations, Towards the end of the century, new systems of health care like NHS Direct, walk in centres and above all the Internet are providing ever more varied and detailed information. Yet more and more of it is impersonal. For the first time in our history, the question can now be asked : will the future of medicine be impersonal? Will it be about machines and impersonal alogarithms?
Tonight, I will try to review the research and offer the view that the human side of medicine remains central.
There are many research reports which provide circumstantial evidence and are relevant Canon (1940) showed that Voodoo medicine could kill fit young adults. Beecher (1955) reviewed placebos and showed that as many as a third of adults will get better if given an inert preparation by a doctor in whom they believed and who was trying to help. The human side of medicine mattered.
By 1957, Balint was demonstrating the central feature of the doctor-patient relationship and this led to the issue of continuity of care. Repeated contact between patient and doctor, ie continuity of care, represents is an interesting illustration of the value of the human side of medicine.
In 1967, Rees and Lutkin?s research became known as ?patients dying of a broken heart? and Medalie and Goldbourt (1976) showed the protective effect for men with angina of having ? loving wife? We have no measure for that! Yet! But every GP knows one when we see one and we see one most days of the week.
In 1979, I coined the term ?personal lists and shown that this could improve health education received by patients.(Pereira Gray, 1979).
Things moved on more quickly in the 1990s as new instruments such as the measurement of satisfaction were developed, one of these ( Baker and Whitfield, 1992). was developed in Bristol.
These soon showed that satisfaction by patients, an important outcome, was greater amongst patients registered in practices with personal rather than combined lists (Baker and Streatfield, 1995).
Everson et al (1998) examined the risk factors for death amongst men with ischaemic heart disease. She found that one major risk factors was if the man, at baseline examination, answered ?Yes? to the question ?Do you ever feel hopeless?.
Most recently, new measures of quality of assurance, especially, in the USA, have shown that for most of the measures of good process in the care of diabetics and for outcomes, as measured by the HBA1c, results are significantly better amongst patients who report having a regular provider (O?Connor et al., 1998).
In conclusion, I accept that human interaction has its own side effects and can sometimes not be beneficial for the patient. I agree that the development of impersonal treatments and health care systems is increasing rapidly and that some of these like the Internet will continue to grow.
Nevertheless, I continue to believe that, despite all this, there remains a major role for the human side of medicine.