What would Hippocrates Do?
Hippocrates was a holistic practitioner intent on treating the complete person, whereas today we tend to specialize in exquisitely narrow fields of anatomic and physiologic knowledge, leaving the balance of the human body to our colleagues. Hippocrates was a devoted and objective empiricist, while most modern doctors spend so little time with each patient that it’s absurd to claim serious observational skills. Hippocrates was a consummate communicator, while today’s doctors (ask our patients) are walking communication nightmares. Hippocrates felt and demonstrated sympathy, while we’ve chosen a colder, more “scientific” model for doctor-patient interaction….
In his teachings to neophyte practitioners and students, Hippocrates cautioned physicians to “make no pretense to infallibility.” As one might expect of a physician practicing in an age before the accurate elucidation of human function and disease, he was acutely aware of his lack of knowledge. Given this lack, his success as a physician and a physician-educator is mystifying. Despite subscribing to the “humors” theory of human health, despite knowing neither the location nor the function of the human heart, and despite being unaware of staple concepts like oxygen or the passage of blood through arteries and veins, Hippocrates was heralded as a man of medical science whom his patients and students loved, and whom the Western world lionized. How can someone with little to no true scientific knowledge still be seen as the great master of medical science?
This quote, from a new book titled – Hippocrates’ Shadow: Secrets From the House of Medicine – speaks to the issue that I raised yesterday. I revel in understanding the science of medicine. I teach acid-base and electrolyte disorders and stress an understanding of renal physiology. I balance talks with physiology and clinical trials. Yet I understand that all the science in the world only serves as an underpinning for the doctor patient therapeutic relationship.
Do we spend too much time in medical school focused on “science”? Perhaps we do. We certainly use selection processes which reward a scientific bent. The required pre-med curriculum is all about science.
Many clinician educators understand the importance of teaching the bedside approach to patients. Many do not.
Certainly many practicing physicians understand. My experience suggests that internists, pediatricians and family physicians are more likely to understand the importance of the doctor patient interaction than are subspecialists. Now ever generalization has major exceptions.
My experience suggests that those with outstanding doctor patient interactions more often choose private practice than academics. I see too many academicians who do not understand these issues.
In my opinion, we do have a problem, and I am at a loss to craft a solution. I personally will continue trying to be a good role model, and to encourage this behavior in junior faculty. My experience suggests that students and residents recognize good bedside role models, and cherish them.
