The Art of Medicine.

The Conversation.  Pt 2.
             
The  conversation between physician and patient is the most important aspect of the art of medicine as distinct from the science of medicine.    Art means skill, craft, craftsmanship, and traditionally has only been a part of medical education is so far as the student could observe it being practiced (or not practiced)  by his teachers.  Thus it was a hit and miss affair as to whether your mentor was a William Osler or a Josef Mengele.  One of the most promising signs of change was the recognition that the art needed to be recognized and to be taught and in the fifties and sixties the foundation of organizations such as the College of  General Practitioners of Great Britain, the College of Family Physicians of Canada and the American Academy  of Family Physicians seemed committed to focus on these areas.  Simple and obvious aspects of conversation were recognized, including the fact that the patients should understand the nature of their illness and its treatment and feel sufficiently comfortable to ask questions.   The physician's understanding of the myriad factors that influences the patient's welfare and ability to cope with their disease has an impact on the effectiveness of any treatment regimen.  This is what patient centred care was supposed to be all about.  Although the above mentioned organizations made some impact on teaching students to interact with patients and introduced hitherto uncommon methods for observing the quality of communication and interaction  between patient and doctor, there are other influences that that are diminishing the initially favorable impact of such methods.   It is still true that some students go through their program without having their skills  adequately observed in  the practice of the science or art of medicine.   The various Colleges have taken  their eye off the ball and often seem to be focusing on the wrong thing.   I sometimes wonder whether any medical student ever fails out of medical school today, because just as the practice of medicine has become distorted by fear of litigation, so have the actions of Colleges and Universities.
                 Back to the conversation for a minute before winding up, as a young doctor I found it very difficult to give patients bad news. (Docs are actually human too!)   Most of my patients were young and healthy and had young healthy families, so I didn't often  have to deal with the situation.But every now and then, catastrophe struck.   Initially, I found it really hard to broach the topic.  Thinking about it, I knew there was no way to make bad news sound like good news, no matter how hard I tried.    Instantly I got it, I knew that in  all sincerity I had struck the right honest note, that I used ever since.  This is how I said it, sincerely and regretfully:  "There is no way to make bad news sound like good news, this is what's wrong........."

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