Dear Editor,

The recent BMJ Opinion by Maggino-Hurst et al. offers a moving account of reconnecting clinicians and patients through biographical narratives. However, the initiative also reveals a deeper systemic issue: in many clinical settings, diagnosis and care have become structurally dissociated.

Physicians are often trained—and constrained—not as companions in care but as diagnostic experts. The act of caring is delegated to nurses, for whom self-disclosure and conversational ease are typically second nature. Meanwhile, medical interviews are reduced to checklists, and physical examinations to technical formalities. This is not due to a lack of empathy, but to a lack of time, institutional support, and systems that reward caring.

By contrast, traditional East Asian medicine and many complementary and alternative medicine (CAM) systems operate under a different paradigm—one in which diagnosis and care are never truly separated. Pulse diagnosis, tongue inspection, and abdominal palpation are not merely diagnostic techniques; they also function as openings for dialogue, trust-building, and access to the patient’s worldview.

Touch-based diagnosis can itself be a conduit of care, safety, and trust. As a phenomenological study in osteopathic medicine has shown (Considine et al., 2015), touch plays a central role in communicating professionalism, compassion, and therapeutic presence to patients. In such settings, knowing hands are talking hands, and the examination becomes a moment of mutual recognition—not merely information gathering.

The key lesson here may not be to “add narrative” to medicine, but rather to reintegrate diagnosis and care as mutually reinforcing acts. Without this reintegration, narrative interventions risk becoming yet another item on an already overburdened clinical checklist.

Reference
[1] Considine S, Standen C, Niven E. Knowing hands are talking hands: the experience of osteopathic touch. Int J Osteopath Med. 2015;18(3):182–191. https://doi.org/10.1016/j.ijosm.2015.06.002

Kenjiro Shiraishi
TANASHI-KITAGUCHI Acupuncture Clinic
Nozaki Bldg. 301, 2-9-6 Tanashicho, Nishitokyo City, Tokyo 188-0011, Japan
https://orcid.org/0009-0003-2550-7385
Acupuncturist and researcher
Twitter: @gmjaptdtmjgatpm