297: Comfort Always: Why Technology Can’t Replace the Human Art of Healing, With Alan R. Cohen, MD

After 40 years as a pediatric neurosurgeon, Dr. Alan Cohen has seen some of medicine’s most extraordinary miracles and most heartbreaking moments.

In this episode of The Human Side of Leadership in Healthcare, Dr. Pelè sits down with Dr. Cohen, Chief of Pediatric Neurosurgery at Johns Hopkins and author of Comfort Always: Healing in the Age of Technology, to explore a question healthcare must continue asking:

As medicine advances, what must we never lose sight of about the human side of healing?

Dr. Cohen shares gripping stories from a lifetime of caring for children and families facing the crisis of their lives, and reflects on the emotional realities of medicine that technology can never replace.

In this conversation:

• Why healing and treatment are not the same thing
 • What patients remember long after the technology is forgotten
 • How compassion shapes trust under pressure
 • The emotional weight physicians carry in high-stakes medicine
 • Why AI must never replace the patient-doctor relationship
 • The simple human behaviors that patients remember forever

One of the most memorable lines from this episode:

“Technology treats the disease. Humanity heals the patient.”

A powerful conversation about medicine, leadership, compassion, and the forgotten art of healing.

Connect with Dr. Alan Cohen on LinkedIn: [ HERE ]

Get his book, Comfort Always, on Amazon: https://amzn.to/4fDhUpJ

Transcript

Welcome And Why Healing Matters

Dr. Pelè 0:07

Welcome to the Human Side of Leadership and Healthcare podcast. I'm Dr. Pillet. On this podcast, we explore how leadership shows up in real moments, not just in theory. And today we're talking about something medicine as a whole can sometimes overlook in the age of technology, the forgotten art of healing. It is truly my pleasure to welcome Dr. Alan R. Cohen, Chief of Pediatric Neurosurgery at the Johns Hopkins University School of Medicine. Dr. Cohen is a pediatric neurosurgeon, professor, teacher, and now author of his newly released book, Comfort Always: Healing in the Age of Technology. Alan, I'm really glad you're here. How are you doing today, sir?

Dr. Alan R. Cohen 0:55

I'm doing great. It's a pleasure to be here. Thanks for that wonderful introduction.

Dr. Pelè 1:00

Well, you know, we got to start with you. First of all, I see the heavens behind you, but I'm sure that's not where you are. Where are you calling in from right now?

Dr. Alan R. Cohen 1:08

This is my Zoom picture because I'm calling from the clouds, but actually I'm in my office at Johns Hopkins.

Dr. Pelè 1:14

Absolutely.

Technology Versus The Human Bond

Dr. Pelè 1:15

No, that's powerful. You know what? Let's get straight into your story. You know, after four plus decades in pediatric neurosurgery, what has your work taught you about human beings that no medical technology or textbook ever could?

Dr. Alan R. Cohen 1:33

Well, I have the privilege of being able to take care of children with life-threatening illnesses. And I've collected stories over the past four decades of my patients and their families that are more gripping than I think anything that you could see on television, because this is uh some of the uh life's most difficult times that patients face. And I deal with families facing the crisis of their lives, and I've been marveled by the resilience of these kids and their families and how they navigate through that. And so as a pediatric neurosurgeon, I've spent a lot of time writing for the medical community about the technology. Uh, this is the first time I've written for the general public uh about the humanity involved in medicine and surgery.

Dr. Pelè 2:23

Wow. So you've already made a distinction that I think is powerful. You're saying that on the one hand, there's technology, you know, the electronic medical records, the uh gosh, all the robotic new stuff that's happening. You're saying the technology is on one side, but you're saying there's an equally important thing on the human side. Tell us more about that sort of uh continuum.

Dr. Alan R. Cohen 2:44

Exactly. This is a book, Comfort Always, and it's about the forgotten art of healing in this era of high technology. And as you mentioned, we have things like the electronic health record that can do unbelievable things, transmit information across the world. Uh but uh this is uh an account of the lessons I've learned in four decades of caring for patients. And uh one, I try to showcase uh the important advances that technology has allowed us to do. We can do things now uh with intraoperative MRI and ultrasound and lasers and microscopes and endoscopes and exoscopes, things that we couldn't even do a couple of decades ago. Uh and it's a wonderful advance, but technology, if it's not managed appropriately, can tend to drive a wedge between the doctor and the patient and the family. And that's the point that I'm trying to make is that uh both technology and humanity are synergistic in the healing. And I'm trying to emphasize the second, the non-technical aspects of healing in this modern age of technology.

Kindness That Patients Actually Remember

Dr. Pelè 3:54

Wow. You know, I can't tell you how uh deeply truthful and emotional uh your words are because I I went under the knife. Um, you know, I had a prostate uh health scare, uh, had that removed, but I gotta tell you, I don't know anything about the robotics. I can't remember the technology, but I do remember the powerfully emotionally connected doctor who helped me work through this process. So, you know, I hear you. Give us maybe one example in your life, maybe something you've written in your book that really talks about this relationship between the patient and uh the doctor. This, as you say, something that's being lost in today's world.

Dr. Alan R. Cohen 4:35

It's being lost, but it's it's something that we all know about. It's just that it's easy to dismiss in this complex era, what I call the business of medicine, where we have this electronic health record where sometimes I have an excellent primary doctor myself, but sometimes if you look, the doctor has become uh a healthcare giver and the patient is a client. And there's a business of medicine where uh sometimes you'll see the physician uh with his back or her back while they're entering um uh information into the computer. And the book is a rec uh a recognition of that and a uh a chance for the doctor to take his or her hands off the keyboard and lay them on the patient to remember that relationship. These simple things like kindness and compassion and empathy, optimism, humor, hope, uh, these are the things that tend to be forgotten. And some of these simple things go a long way. Just like in your case, you don't remember the technology that helped get you through, but you remember the doctor and the patient and this empathy and humanity is something that's important. And if it's not there, the patient and the family remember that.

The Case That Changed Everything

Dr. Pelè 5:47

Wow. You know, in a in an esteemed career uh like yours, could you give us one moment that really uh stays with you and has stayed with you long after the surgery is over and all the things you've been working on are over? What's one memory that really stays with you?

Dr. Alan R. Cohen 6:06

Well, these stories, uh all of them are are very powerful. And uh sometimes I've tried to do readings of some of the chapters, and I myself get emotional about it because uh the stories are gripping. There was a case before I came to Johns Hopkins when I was at Harvard Medical School in Boston Children's Hospital, where a two-month-old uh infant girl was referred to us because before she was born, uh she had an ultrasound and then an MRI while she was still in her mother's uterus. And she was diagnosed with Down syndrome, which is a genetic abnormality, uh, but she was diagnosed with an inoperable malignant brain tumor that filled the entire left hemisphere of her brain. And the doctors came from out of state, made plans with the family out of an abundance of compassion to have them deliver the baby and take her home immediately for hospice care to prepare to bury their newborn child. And the mother and the father were very, very emotional and very smart. And mom wrote brilliantly uh in a blog about the experience, what it was like when they took her baby uh when after she was born to the ocean uh to feel the sand and see the water, thinking that the next time they would be there would be to bury their child and spread the ashes. And they came for another opinion and we looked at the films, and it was a huge tumor. It filled the hemisphere of the brain, but she started getting a little bit better, and we said, we don't want to give her a death sentence. Let's take a look. And we went to the operating room when she was two months old and opened the head, and we found a huge tumor, but it didn't look like a malignant brain tumor. It ended up being a benign brain tumor, a rare tumor, and we were able to remove it. It was a tumor called a desmoplastic infantile ganglioglioma. It's a lot of doctor words, but it from the World Health Organization was grade one, which is the most benign tumor that you can have. And we were able to remove it, and that was 11 years ago. And she's home with her family, she's in school now, she's a loving kid with loving parents, and their lives have been changed by the fact that uh we took a look, we took a chance. And that's the story. Sometimes, you know, never be too ingrained in your ideas and always keep an open mind. That story is one hard to forget.

Leadership Under Pressure At Bedside

Dr. Pelè 8:26

Wow, that is a fascinating story. And, you know, on this podcast, we like to talk about the relationship with leadership when it's under pressure. Like obviously, there was a lot of pressure in that story you shared, and how that actually affects patient outcomes. Um, I'm wondering if, you know, you have a perspective of the idea of leadership behaviors, being able to spread hope and compassion, as you've described, even under the, if you will, under the gun of having to get uh care delivered to patients. What does that moment look like?

Dr. Alan R. Cohen 9:01

Well, it's a moment that's not new, it's been there in history. And there's a famous quote from uh Moses Maimonides from about a thousand years ago. He was a rabbi and a philosopher and a physician, a Jew who lived in Egypt, and he famously said that uh may I never forget that the patient is a fellow creature in pain. May I never consider him merely a vessel of disease. And you know, as you mentioned, there is a hierarchy in medicine and surgery, and uh we tend to be busy. We I I myself have been guilty of this in my training. I have three patients with hemorrhages, three hemorrhages in the emergency room and two tumors in the ICU and uh a spine fracture in the in the uh OR. Uh but remember that the patient is a person and that has a grieving family. Uh, and and so it's important to break down that barrier. Uh they tell us in medicine to keep a distance between the doctor and the patient. In my field, in particular, in pediatric neurosurgery, I don't think that's the case. Uh we have a very intense and close relationship with our patients and their families. We almost become a member of the family. And I think that's important in the art of healing, to break down the hierarchy.

Carrying Emotional Weight In Care

Dr. Pelè 10:14

Wow. You know, I told you earlier before we started our conversation that my uh experience in healthcare is that I've been a human resources vice president at a hospital. Uh, what I didn't tell you is that my wife is a an ER physician. And so when you talk about, you know, the emotional cost, if you will, if you will, of healthcare and of caring, I feel it every day. I'm wondering.

Dr. Alan R. Cohen 10:38

Imagine Imagine what she must feel when someone comes in with a serious illness and she has to make a decision, and the family has no idea who she is, and they have to trust her with uh her judgment. It's a terrifying thing for the family to go through. And just the recognition of that, I think, is important.

Dr. Pelè 10:55

Yeah, it is. And you know, I wonder, you know, obviously, pediatric uh neurosurgery carries enormous emotional weight, um, families and and everything concerned with that. How have you personally learned to carry that kind of emotional weight over time?

Dr. Alan R. Cohen 11:12

Well, you try to put yourself in the patient's position. What's it like to be on the other side of the bedrails? And understanding that, I think it helps go a long way. I think the uh thing to remember is that technology treats the disease and humanity heals the patient. And it's a combination, there's a synergy there. Uh, it's important to remember uh the both of those. Uh in my field, uh, my uh special interest has been in pediatric brain tumors. And uh pediatric brain tumors have the unusual distinction of being the number one cause of uh solid tumors in children and the number one cause of cancer death in in kids. Uh and it's a terrifying ordeal. The most difficult thing I can ever imagine that I have to do is to tell a parent, I'm sorry to have to say this, but your child has a brain tumor because I know it's going to change the life of the entire family. And now with technology, uh, we can do a lot more than we could before. We can uh remove these tumors, and in some many cases, we can save the patient's life. Uh but uh it's important to remember uh that we're dealing with human beings. And um, the words there's a person named William Osler, who was one of the founding fathers of medicine. He he was one of the founding fathers of Johns Hopkins. He started in 1889. He famously said that uh the good physician treats the disease, the great physician treats the patient who has the disease. And that's the message of the book. It's about the humanity in medicine and the forgotten art of healing.

Dr. Pelè 12:49

You know, uh, Al, you asked me to call you Al. I'm gonna I'm gonna get personal here because you said something that I think is also just powerful. You just said technology treats the disease, but humanity heals the patient. I hope you've copywritten that because that's powerful.

Why Write Comfort Always Now

Dr. Pelè 13:06

Um, you know, I have to ask you, what why did you feel that now was the time to write Comfort Always?

Dr. Alan R. Cohen 13:15

One of the best things about being a pediatric neurosurgeon is that I get to follow the lives of my patients and their families over time. And I really had no idea that there was a field of pediatric neurosurgery, even when I was in medical school, but it's a very unique experience. And so uh what's happened is I have patients that I followed for 30, 40 years right now, patients of mine who were babies when they had a brain tumor, and now they're adults with their own children. So it's a unique perspective. And I thought it would be a good time uh, as I'm coming toward the latter part of my career, to reminisce about that and share those stories. The people that I've written about in this book are real people, real families, and they were very generous with their time, and I've used their real names. This is not something that's fiction, this is nonfiction, but it's more gripping than some of the stories that we see uh on television.

Dr. Pelè 14:11

Wow. Well, you know, what I was gonna say is that, you know, you mentioned, you know, the field of pediatric neurosurgery. I have to tell you, you know, my daughter, who's 20 years old, is studying at Texas AM. Guess what for? Pediatric neurosurgery. Wonderful. She's in neuroscience right now, and that's her ultimate goal is to be basically uh someone like you someday, you know. So I'm very excited to be learning these things from you.

Dr. Alan R. Cohen 14:36

Well, you can tell her it's really not that difficult. If you can say a few words in Latin and tie your shoes, you can do pediatric neurosurgery. But it does take a long time to get there to learn the secret handshake.

Dr. Pelè 14:48

That's powerful. Dr. Cohen, what do you hope physicians take from this book? What is the big takeaway that you want physicians, maybe patients, and everyone else to take from this book?

Dr. Alan R. Cohen 14:59

Yeah, I tried to write it for a general audience. Uh, and that is uh, I hope that people will enjoy the book. Uh and uh what I've tried to do is tell human stories, talk about the beauty of the nervous system and the pleasure of doing differential diagnosis to be able to sort things out. Uh, the human brain is a very remarkable structure, and it can be very imposing. Uh, but learning the beauty of the nervous system allows us, like a detective story, to unravel mysteries and find out a diagnosis, then be able to do something about it. So it was written for the general public, uh, but also for people in the medical profession to remember this uh art of healing, this fellow Osler that I told you about, the great physician treats the patient who has the disease. This was back in the early 1900s. There's a picture of him at the bedside of a little girl who's uh recovering from a medical problem, and he's playing with her doll. Uh and he was probably the most famous physician in the world at that time. And here he is at the bedside, sitting with a patient, playing with her doll. And for the for the physicians and the surgeons and the medical people, sometimes some of the simplest things that we do, uh helping a patient get a glass of water, changing the covers on them, manipulating the pillow, are things that they remember more than anything. And so don't take anything for granted, but just being that compassionate person at the bedside goes a long way with the patient and the family. And it's very gratifying to have a relationship that like that uh with the family. The hours are long, the work is arduous, but the return is really unremarkable. I mean, it's unbelievably good.

AI In Medicine Without Losing Trust

Dr. Pelè 16:44

You know, we live in a healthcare world uh increasingly shaped by technology like AI, uh, you know, and data uh all over the place. What parts of medicine must never become automated, in your view?

Dr. Alan R. Cohen 16:59

Well, you know, AI is coming down the pike at a very fast rate, and it's scary about some of the things that could happen. On the other hand, if it's used judiciously, uh sometimes we have uh a patient that comes in with a questionable diagnosis and an unusual MRI. And the ability to use AI to compare that scan with 10,000 others can help us in the diagnosis. But I don't think AI will ever replace the patient, the patient-doctor relationship, the bedside uh healing uh that's there. So I said it's I think now the challenge is going to be the judicious use of computer technology and artificial intelligence in in the uh care of patients.

Dr. Pelè 17:40

Yeah, no, I I couldn't agree more. Uh, you know, for anyone listening uh at this moment who's either a practicing physician or uh desiring to become one, you know, paint a picture for us. What does compassionate care actually feel like to a patient? What are the behaviors, for example, maybe even just one behavior, that people uh who want to be practitioners can begin to hone in order to become better at this human side of of uh of uh patient care?

Dr. Alan R. Cohen 18:10

Well, there's no one easy definition of uh of caring or compassion. Empathy is uh trying to be being troubled by someone else's trouble. Um the old uh Supreme Court Justice Potter Stewart, uh describing pornography, said, uh, I know it when I see it. And with empathy, the patient and the family knows it when it's not there. Everybody may express that differently, but and and you need to be yourself, but caring means being troubled by another's trouble. And I think that's an important part of doctoring. And it tends to get

What Compassion Feels Like

Dr. Alan R. Cohen 18:45

ignored in this explosive era of huge technology.

Dr. Pelè 18:49

I I couldn't agree more. Uh, it is the thing we remember, that it's that human side. It's it's also the thing, I think, as you said, that brings, you know, great a sense of appreciation even for the doctor, right?

Meeting Kids Where They Are

Dr. Pelè 19:02

Um, so tell us a little bit more about what you're working on right now, besides talking about the book, anything exciting that we can come and find you on, any new upcoming uh launches of anything, something we can learn more about, Al Cohen.

Dr. Alan R. Cohen 19:18

Well, one of the things you may not know is that in order to help develop this bond between the doctor and the patient, we sometimes in pediatric neurosurgery have to have the mentality of a five or 10-year-old. And my colleagues uh told me that I really have no difficulty doing that. But one of the things that we were doing for some period was um on January 8th, which I'm sure you remember is the birthday of the king, Elvis Presley. I would get together with my patients in a rhinestone suit and we'd do a karaoke celebration uh of the king. And these kids would come up on a stage in the hospital. It was a chance for them to kick back and relax. They'd never even heard of Elvis, but they were fearless behind the microphone. And I just always wonder how brave these kids were. Sometimes they're the kids that help their families get through the ordeal because it's a life-changing, life-threatening condition that they're through. So we uh now uh my family who's heard me sing has told me not to quit my day job. So uh it's only so far you can go without talent, but I've tried my best. Oh, well, you I see you've got a guitar in the background.

Dr. Pelè 20:29

I can see my guitar in the background. You're you're you're talking to someone who's right there with you. I I can totally understand the power of uh, as you say, thinking like a child and being able to step into their world. Um, to and that in itself is part of the healing. It's so fascinating for me to learn that directly from someone like you. After

What Healthcare Must Never Forget

Dr. Pelè 20:50

40 years in medicine and in in at leadership levels uh where you've been, what do you hope healthcare never forgets about the human side of healing?

Dr. Alan R. Cohen 21:02

Well, exactly that. That, you know, uh again, with all these adjuncts that we have, uh Maimonides would never dream that we could do the things that we can do. Uh but just to remember that these are uh adjuncts, they help us and they can allow us to do better things in the OR and in the clinic as well. Uh but it's that human connection that tends to get overlooked. So uh again, uh the there's a price. Technology comes with a price that's not only financial, but that wedge that it has the potential to put between the doctor and the patient and the family is something. As long as people remember that, I think they'll deal with it. And everybody deals with it differently, but it's important not to forget it.

Dr. Pelè 21:45

Dr. Al Cohen, you know, there are moments that happen in your life where you know that's the moment where everything changed. I got to tell you, speaking with you, learning from you, it feels like that for me. Thank you so much for being here on this podcast. I really appreciate it.

Dr. Alan R. Cohen 22:00

You're very kind. I've enjoyed it a lot. Thank you very much.

Dr. Pelè 22:04

All right.