Dr. Ulloa had been confident that she wanted to train in medicine since she was a teenager, working as a shampoo girl at her mother’s salon in Millis, Mass. She’d spent long afternoons lathering her hands in floral-scented pink liquid and massaging it into the clients’ hair. She liked the intimacy of it. The women tilted their heads into her hands, asking her questions while she rinsed: What did she want to do when she was grown up? The answer came easily. She wanted to be a doctor, which seemed to have qualities in common with being a shampoo girl. It was about earning someone’s trust, fostering a certain kind of openness while you ran through your set of tasks.
But all she could do on that first day in the Covid wards was move quickly among her patients, willing herself not to linger. She grasped for the right words of comfort before going on to the next bed.
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With the invention of the stethoscope in 1816, the gap between doctors and their patients grew profound. Using that instrument, physicians could extract information from their patients without even pressing ear to chest. That tool helped turn medicine from a trade into a profession. When people fell sick, they no longer turned to a neighbor or local healer; they knew they would get authoritative care by seeking out a physician.
In the mid-1900s, that dynamic began to change, as it became clear that patients needed to have some rights, too. The shift was accelerated by the 1947 trial and judgment of 23 Nazi doctors and bureaucrats. They were indicted, facing charges related to torturous experimentation on their victims that included mass sterilizations, bone-grafting and forced exposure to drugs. The physicians claimed that they had no medical code of ethics limiting their behavior. The Nuremberg Code that emerged called for the “voluntary consent” of subjects in human research — in other words, for the first time, patients had to know what was being done to their bodies.
In the decades that followed, other physicians began to take the idea further. Dr. Jay Katz, an ethicist at Yale, argued that patients should be involved in their own medical choices. His landmark book “The Silent World of Doctor and Patient,” published in 1984, challenged the paternalistic assumption that patients should quietly accept all their doctor’s ideas.
By 1996, Dr. Bernard Lown, a cardiologist, was arguing that the biggest problem in America’s broken health care system wasn’t about money but compassion: “Healing is replaced with treating,” he wrote. “Caring is supplanted by managing.” Instead of tending to full humans, doctors were treating distinct organs like a car mechanic examining malfunctioning parts.
Medical schools began to teach these once-radical ideas to their students. Faculties put a new emphasis on notions like informed consent, training would-be doctors to build relationships with their patients and not just expect compliance. This seemed all the more important for the most sensitive hospital conversations: If you are going to ask patients at what point they’d want to forgo life-sustaining measures, for example, then you’d better have earned their trust first. You’d better sit with them and get to know their families.
