Question

I once asked a clinical colleague to describe what it had been like working as a trainee with a worldfamous surgeon. His response was surprising, and troubling – “Oh… he’s brilliant and talented, of

course, but to be honest – he’s dangerous. He has become more or less indifferent to patient suffering,

and even death – I guess because he has seen so much of it.”

Although infrequent, this type of desensitization, or inurement, unfortunately does occur in clinical

settings - whereby health care workers that are constantly exposed to suffering become “numbed” to it

over time.

Hannah Arendt, the German-American philosopher, coined the term “banality of evil” in her New

Yorker series covering the Nazi war criminal trial of Adolph Eichmann – suggesting that blind

allegiance to authority can lead to indifference to suffering. Although she was aggressively criticized by

many for implying an apology for the Third Reich’s role in the Holocaust, those investigating the topic

(most notably Stanley Milgram in his experiments illustrating that college students, given the

instructions to shock others by an authority figure will do so repeatedly) have supported her theory.

Despite the fact that desensitization, and the “Milgram” effect are real, what I am really concerned about

in health care at this particular “decisive turning point in history” is neither of these – what worries me is

“distance.”

Could the use of technologies that distance health care providers from the first-hand experience of the

suffering of those they care for (such as telemedicine platforms and other forms of “virtual visits” or

self-care tools) lead to a collective “stumbling over lines” with unfortunate consequences? On one side

of these lines is empathy and understanding of the nature of suffering, and on the other, a loss of that

perspective.

I recently spoke with Dr. Eric Cassell – a pioneer in the development of the specialty of Palliative Care.

He wrote a landmark article published in the New England Journal of Medicine in 1982, entitled “The

Nature of Suffering and the Goals of Medicine,” and later edited a well-respected textbook by the same

name. We discussed both the possibility that technology could increasingly distance providers from

suffering, and the fact that many physicians are “burning out” in a time when technology should actually

be making their jobs easier.

“They are related,” he said. “The problem that physicians have now is not that they get too close to their

patients, but that they do not get close enough. The suffering have special therapeutic needs, and those

aren’t met by technology alone.”

Dr. Rushika Fernandapulle, the co-founder and CEO of Iora Health, a company that is growing a new

model for primary care delivery leveraging high tech and high touch, shared his thoughts. “The thing

that heals people is relationships – the problem is that technology has the ability to actually facilitate

relationships, but it can also get in the way of them.”

Karl Marlantes’ book about his experiences in Vietnam as a young soldier, “What it is Like to Go to

War” examines the social and psychological consequences of fighting, killing and returning from those

experiences, and provides an interesting analogy. He asserts that the contemporary use of drones and

cruise missiles, and the lack of subsequent exposure to the suffering and damage that these weapons

cause – may have important unintended consequences.

a. What is the main purpose of this article? [5 Marks]

b. What are the main scientific questions the author is addressing? [5 Marks]

c. What key concepts do we need to understand in the article? [5 Marks]​

Answer 1

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