A little of that human touch

AI isn't the enemy. But there's no substitute for our humanity.

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Last week I had the immense pleasure of spending an afternoon at the glorious new V&A East Storehouse in London, an immense and ambitious new kind of museum that, to be fair, finds itself lately compared to a big old IKEA.

As someone who tends to snooze out when it comes to decorative arts, I was blown away by how profound the experience of walking around the space was. An extremely English in its execution hodgepodge of eclectically grouped chairs, chests, prints, entire rooms, and a stage curtain that took my breath away, the collection brilliantly showcases the seriously tender work of conservation and, by extension, care itself.

Why, exactly, can’t I live here?

There’s something really moving about seeing an object that someone made hundreds or thousands of years ago — maybe a carving, maybe a corset — a thing of worship or utility, and then seeing the delicate preservation that someone else has done to maintain it. Little support pillars around fragile tables. Well-identified boxes containing old hats. It made me think of the line from Ruth Ozeki’s A Tale for the Time Being: “I’m reaching forward through time to touch you … you’re reading back to touch me.” Isn’t that beautiful?

This is care. Care that extends into the past and the future, but also the kind that is very much present. The skillful kind that comes from knowing how to treat a piece of wood or stone or canvas or a person, so that they don’t deteriorate. So they shine.

Several years ago, my daughter spent a night that I can only describe as harrowing in the hospital. I stumbled out into the hall that morning she’d finally stabilized to try to find something to prop myself up. The coffee and tea station was entirely bare, and as I fruitlessly poked in drawers for, I don’t know, a tea bag to suck on? an orderly told me they were all out of supplies on the floor. And he saw the exhausted, disappointed look on my face as I staggered back to my daughter’s bedside. He saw me. Then, about a half hour later, he found me. He was bearing a cup of tea. I will forever be grateful to the doctors and nurses who saved my daughter’s life. And I will never, ever forget the person who brought me a measure of comfort and grace on probably the hardest morning of my life.

That experience should not and doesn’t have to be an exception. Empathetic, thoughtful care isn’t just a nice idea but hey, we’re all too busy, right? I know we’ve all become numb to the enshittification of everything, including our healthcare, but good care is good for business. Mass General now offers an Empathy and Relational Science Program, because, as they put it, “The degree of clinician empathy plays a significant role in improving outcomes in medicine, predicting quality of care, patient safety and satisfaction, and in decreasing malpractice claims.” The kindness that orderly showed me solidified that hospital in my mind as a trusted place to go for emergency services, (and yeah, we’d need them again), and be more patient and accommodating when we returned.

In Richard M. Frankel and Terry Stein’s seminal “four habits” model for clinical communication, they noted that “40% to 80% of patients who receive recommendations do not follow them,” and pointed out the link between “absence of supportive, empathic communication and medical malpractice suits.” These figures can be moved significantly, they argued, when clinicians “seamlessly blend the logic of clinical decision making, which is the basis for making an accurate diagnosis, with the logic of social interaction.”

Frankel and Stein wrote that back in 1999, long before the explosive automatization of care and the rise of artificial intelligence. We now have too much decision-making logic, not enough of the social interaction kind. I think most of us who have a modicum of emotional intelligence can be grateful for anything that offloads some of the burdens on healthcare workers and patients alike. AI has been a godsend in improving diagnoses of diseases like breast cancer, assessing risk, and even helping patients navigate through their mental health symptoms.

It can’t yet, however, bring you a cup of tea when you’re on your last good nerve. It can’t put a hand on your shoulder and tell you, “We’ll figure this out.”

Frankly, as far as I can tell, the world is now mostly run by men with terrible social skills overcompensating for a lack of affection in their childhoods. And it shows! The drive toward what to certain brains looks like efficiency, and the insistence on faster and faster and less and less human interaction, has become a real clown show on multiple levels. And surprise, it’s leading to worsening health outcomes.

We are all now in too many ways at the mercy of people who aren’t good with people — or things, come to think of it — who’ve convinced the world that their deficient skill set is aspirational. It’s like the old wives’ tale about the Castilian lisp, except for sociopathy. (The sexist trope that working well with others and communicating clearly are considered “soft skills” makes me want to crawl under a rock forever. You think my skills are soft? Fuck you. How’s that?) Just remember that when our healthcare feels inhumane, it’s because the people at the top don’t know how to not be inhumane.

See and I’d have said wealth redistribution.

We have been forced to go along with the lie that caring about and for anything is wasteful and weak, which in addition to being very screwed up is also bad business. I’m just a simple lass without an MBA, but having satisfied patients who don’t develop complications or sue you, and doctors who aren’t fleeing the field like it’s on fire, sounds like a plan to me.

I’m reminded of Linda in Nancy Mitford’s The Pursuit of Love, musing that “She simply could not understand how somebody who already had plenty of money could go and shut himself away from God’s fresh air and blue skies, from the spring, the summer, the autumn, the winter, letting them merge into each other unaware that they were passing, simply in order to make more.” It was all supposed to be so we could have nicer lives, not so five men could just have more money. We’re moving fast and breaking things, and what we’re breaking can’t be replaced.

We can’t be mindful every second of the day; I can only devote myself so much to my toothbrushing or whatever. But we can recognize those opportunities for the kind of care that only humans can do when they present themselves, like a curator in the zone in that one square centimeter of a painting, like Olivia Coleman peeling mushrooms on The Bear, like an orderly bringing a paper cup of Lipton to a weary parent. That stuff is not getting in the way of getting important things done. That is the important stuff.