Friday, November 16, 2007

The Art Of Medicine

In the 25th Anniversary issue of Health Affairs, we find a compelling article by Dr Jerald Winakur. He reminds us that the ability to listen is a fundamental aspect of the "art" of medicine, and in so doing, warns against against the sole use of technology to assess patient status.

"One of the great lessons I have learned as I worked at my profession over the years is that the "art" of medicine is the honed ability to listen. The practice of medicine—at least the day-to-day, year-in, year-out primary doctoring that I do—involves, in large measure, interpreting stories. Words, not data; nuance, not numbers are the commodities exchanged between my patients and me. I ask a few questions over and over. The answers come in an infinite variety.

By listening to our patients’ stories, doctors glean and process most of the information we need not only to treat ailing bodies, but also to care for our fellow humans as unique beings. It is my job to evaluate and formulate from a constellation of symptoms and concerns and worries, from a blizzard of outside data of often questionable validity. Add to this a mix of freighted family and past medical history, a tendency toward superstition and phobia and fears, and a conglomeration of tidbits and details picked up in the mass media or from well-meaning friends.

I have also learned that it is not necessarily what patients tell me but what they don’t tell me—what I observe from years of being alert to nonverbal cues—that is often even more important. Those aspiring diagnosticians who are unwilling or incapable of reading this invisible text, who study only a check-marked questionnaire scrawled by the patient while she sat in another room, or who stare remotely into a computer monitor at a robotic encounter, never understand—never begin to hear—the complete story."

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