What's Love Got to Do With It?

How Close Relationships Shape our Lives

Robert J. Waldinger is a clinical and research psychiatrist who directs the Study of Adult Development at Brigham and Women's Hospital and Harvard Medical School. See full bio

June 22, 2009, Depression

Love, Human Connection, and Health Care Reform

What's love got to do with health care reform?

When it comes to health care policy, we keep failing to take seriously the value of human relationships. The cost of this oversight is staggering. Every economic incentive in our health care system steers us toward technology (scans, operations, medications) and away from ongoing doctor-patient relationships where much of what really ails us can be shared and understood. In medicine we spend billions each year on doing and a fraction of that amount on listening and reflecting.

Case in point: Michael was a 30 year-old man who was laid low with a bout of acute back pain. He saw an orthopedist who ordered an MRI and then recommended surgery. In discussing the planned surgery with his primary care doctor, Michael mentioned off-handedly that he and his wife recently separated and that their 3 year-old child had just been diagnosed with autism. Fifteen minutes and several insightful questions later, Michael's doctor had discovered how depressed Michael was about his family troubles. Michael agreed to talk with a psychologist about his concerns, and his wife agreed to join him for marital therapy. Six months later his back pain had subsided without surgery and he was no longer depressed. The total cost of the primary care doctor's extra time and the weekly psychotherapy sessions was a fraction of the cost of back surgery. Yet it is hard to measure how much we save when an unnecessary operation does not take place and when the accompanying lost work days never get lost.

More than half of the complaints that patients bring to their doctors are emotional in origin. Most often, they include troubled or absent connections with loved ones. Studies have shown that loneliness increases our risk of developing heart disease, diabetes, dementia, and a host of other ailments. A troubled marriage can be as hazardous to physical health as cigarette smoking. Depression is one of the costliest, most prevalent, and most under-diagnosed illnesses in the developed world.

We know that sustained, trusting connections with our physicians have enormous diagnostic and therapeutic value. Yet the incentives in medicine are structured to give us just the opposite: hurried encounters with frustrated clinicians who cannot linger to inquire about their patients' lives, and disjointed care by multiple specialists who cannot afford the time to talk to each other. Physicians are paid more to spend 10 minutes reading an MRI than they are to spend an hour diagnosing depression.

The debates about how to fix American health care focus on who will pay. There is far less attention to what we pay for. Human connections are essential aspects of both illness and cure. A health care system that provides insufficient time and reward for attending to these connections remains doomed to higher costs and lower quality, no matter who pays the bill.