The Secret in the Care of the Patient
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The concept of the art of medicine implies much of which is not within the scientific realm. It refers to the interactions between physician and patient, that which falls under the umbrella of humanism. It embodies the stylistic ways in which kindhearted and open-minded physicians practice these traits and signifies the mastery of skill needed for its successful application. Furthermore, this concept entails the more abstract tips, pearls, anecdotes, aphorisms, and best-practiced lessons from exceptional and experienced physicians—those which rarely get disseminated in a formal way to today’s young physician or physician-in-training. Understanding the art of medicine raises thought to multiple questions. How it is that someone can meet a physician and within a few moments conclude that he or she is a good doctor? What happens during an exam room consultation that makes one patient want to follow the physician’s advice and another go running for the door? How do we connect with our patients? Why do we want to connect with our patients, and—most importantly—how can we do these things better?
The American educator Francis Weld Peabody communicated the essential quality of a physician is an interest in humanity. Perhaps the single greatest question this blog will address is: How can we better show our patients our concern for their humanity? Likewise, how can physicians accomplish this while helping others gain freedom from disease and attain their best possible health? I propose the foundation to this answer is indeed the science of medicine. Knowledge learned from completion of thousands of clinical trials and randomized studies and the intricate scope explored through such technological advancements as electron microscopy and the molecular analysis of the human genome are examples of the science of medicine, which has advanced our health. Of course, these must be recognized for their contribution to effective medical practice. My goal in writing this blog is to convey that there is more to medicine than the science, and this notion stems from thousands of years of medical teachings. Even the best practitioners of pure science are incomplete physicians. To be complete physicians we must appreciate the art of medicine. We must learn how best to use this science for each individual patient and for humankind as a whole, through effective communication, respect, and understanding. Not only this, but we must recognize that the technologies available to restore the health of patients are applied not only to disease processes or organ systems, but to people—with unique backgrounds, cultural values, educations, and life experiences.
“That’s fine. I’m with you, so far so good,” you might be saying, “So, what’s the problem here?” Throughout medical school, residency, specialties, and subspecialties some feel we have allowed the science to overshadow the art. Understandably, the art of medicine is not formally taught to the young physician or physician-in-training. At a minimum, this abstract notion is relegated to passing comments from senior to junior physicians. An example of what such a dialogue might sound like follows:
Junior physician: “How did you get such good judgment?”
Senior physician: “Good experience”
(Long pause)
Junior physician: “How did you gain such good experience?”
Senior physician: “Bad judgment”
This is an example of one of the many ways that junior physicians (medical students, residents, fellows, and those beginning practice) learn the art of medicine—a hall side comment, an informal conversation, the dispensing of a clinical pearl here and there. The main reason why I chose to write about this topic is because this style of learning—while incredibly valuable—is not universal or consistent, nor are the same critically important lessons taught to each student physician. I believe we can learn not only from our current mentors but from the lessons of some of history’s greatest physician educators, such as Francis Weld Peabody mentioned in the beginning of this blog. Peabody tried to teach us: "The secret in the care of the patient is to care for the patient.”
Richard Colgan, MD, is associate professor of family and community medicine at the University of Maryland School of Medicine in Baltimore, Maryland. He was the School's nominee to the Association of American Medical Colleges for its Humanism in Medicine Award, the recipient of numerous faculty teaching awards including the School's Golden Apple Award for excellence in teaching. Dr Colgan is the author of Advice to the Young Physician: on the Art of Medicine. For more information, go to www.advicetotheyoungphysician.com
