A Piece of My Mind September4,2013 The Good Physician Ragini…

Question Answered step-by-step A Piece of My Mind September4,2013 The Good Physician Ragini… A Piece of My Mind September 4, 2013 The Good Physician Ragini Bhadula, MD1 Author Affiliations Article Information JAMA. 2013;310(9):909. doi:10.1001/jama.2013.276135  There exist in this world infinite measures and parameters by which we judge the goodness of things. In the field of medicine, in particular, a mastery of these measures is considered the most noble of quests. Thus as physicians we are trained to be confident in our science. In that incredible, edible, empirical! We make recommendations to our patients on a daily basis: Mrs S should lower her cholesterol, Mr M should take that antibiotic. Advice offered reassuringly on our collective confidence in tangible outcomes. Yet a physician is more than the sum of her scientific chutzpah. Medicine in its entirety is as much art as it is science. To the novice physician this concept is unformed, theoretical at best. To the seasoned physician it is care within the context of a profound awareness of the human condition. Mastery of this art is a key component of good physicianhood. Yet unlike science, art is a study of intangibilities. Beautiful, spiritual, elusive. When judging the relative goodness of our art, we are confounded. Who then is the “good” physician? What makes a physician “good” vs “average”? This distinction seems subjective, threatening. In the empirical world, we have tests that can determine the extent of our knowledge, but what scales exist to measure the weight of our empathy? Generally, good physicians are recognized as dedicated, compassionate, and curious individuals. They extol a number of desirable traits. They are distinguished among us as those we would entrust with the care of our loved ones. But how does one measure such faith? While we may be able to identify a particular physician as a master of his or her art, we cannot directly measure that skill. What we cannot measure objectively, we cannot reproduce or learn with certainty and must instead acquire individually by experience. Leaving then the quality of our physicianhood vulnerable to experiential fate. We hope that our encounters with patients and mentors over time will render us masters of understanding and alleviating human suffering, but we cannot be certain. As physicians seeking the best for our patients, this possibility is disquieting. So we try to bring order to chaos. We create curriculums, post surveys, attend workshops, all in the hope that we might understand the formulaic success of exemplary physicians. As a third-year medical student, eager and bright-eyed, I remember experiencing first-hand the frustration of this intangibility while working in an outpatient clinic. It was my second month of internal medicine, halfway through third year. At this point in my training I considered myself an expert at the diabetic visit. I knew what questions to ask, I knew what laboratory values to jot down. I was a polished health care delivery machine. I even made some basic recommendations, all before the attending physician had met the patient. My patient that day, Mrs K, had thus far allowed me to babble on happily with mild amusement and much disinterest in my conversation. Nevertheless pleased with my work, I sought my attending Dr S, certain I had pulled off a flawless encounter. Amused by my enthusiasm, Dr S in his unassuming way waltzed into the room. He introduced himself and began to ask Mrs K the same questions I had, but within 5 minutes it was apparent he had achieved what I had not. Under Dr S’s questioning Mrs K began expressing her fears about her diagnosis. She was worried about affording testing strips and glucometers. She was concerned about how diabetes would impact her day-to-day life. That day I was left both impressed by Dr S and slightly wounded by Mrs K’s rejection. I had asked the same questions. I had smiled my warmest smile, but I lacked that something. That important something that had made Mrs K confide in Dr S and not in me. How could I measure up to a standard that was anything but standardized? In that moment I was frustrated but determined to measure the relative goodness of physicianhood. The flaw inherent in this pursuit is that when it comes to physicianhood, we cannot render unto science that which is not due to science. Yet we are so accustomed to living in a world of dogmatic regulation and proof that we assume that all we see can, or rather should, be dissected for its parts. The truth I eventually realized through my training is that good physicians are diverse, and while there may be general guidelines, there are no formulas. Thus we must accept, against our empirical natures, that the art of medicine is by definition dependent on our individual investments, experiences, and flaws. We may not have tests to numerically measure empathy, but we also do not need them. Art is unique to each physician, and thus it is best perfected through self-reflection. What I lacked in my encounter with Mrs K was a mastery of that self-reflective process. As an average physician-in-training, I had empathy, but the mark of a good physician is the manner of conveying that empathy. In between my examining and advising had I stopped to reflect, perhaps I could have made that connection. Perhaps I could have noticed how little room I had left for Mrs K’s questions. That pause of breath in a string of medical interrogation. That moment of opportune silence that can be filled with thought, emotion, concern, is not something I can measure. It is not a singular quality I need to hone; it is the natural consequence of humble self-awareness. In this way, good physicianhood becomes the flawless expression of our human desire to relate to the pain of others. Excellent physicians inspire faith in the unmeasurable. Their excellence inherent in that space beyond which we can state that something is 41.2% likely or 78% effective. After all, that is the purpose of art, to invoke something beyond that which is purely tangible. Questions : Why did Dr. Bhadula fail Mrs. K? What was missing? What would she need to learn to be a better physician? How could she learn it? Arts & Humanities Philosophy PHIL 43708 Share QuestionEmailCopy link Comments (0)