The Key to a Happy and Productive Professional Life as a Clinician

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THE ART OF MEDICINE

• The Key to a Happy and Productive Professional
  Life as a Clinician

Ronald E. Henderson, MD Professor Dept.
Obstetrics and Gynecology
Medicine ConferenceAugust 8, 2006
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THE ART OF MEDICINE

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The practice of medicine in its broadest sense
includes the whole relationship as a physician to
his patients, it is an art, based to an
increasing extent on the medical sciences, but
comprising much of that skill remains outside the
realm of any science. The Art of Medicine and
the Science of Medicine are not antagonistic but
supplementary to each other. There is no more
contradiction between the Science of Medicine and
the Art of Medicine than between the science of
aeronautics and the art of flying. Good practice
presupposes an understanding of the sciences
which contribute to the structure of modern
medicine, but it is obvious that sound
professional training should include much broader
equipment.

• Dr Francis W. Peabody The Care of the Patient
  March 1927, JAMA 88877-882

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Definition of the Art of Medicine

• The manner in which we apply our knowledge,
  skills and experience to our patients one
  patient at a time

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Four Major Categories -

• Communication (bed side manner)
• Proper use of the patients history and physical
  exam
• Learning to apply your knowledge and skills in
  caring for the patient
• Proper use of the ancillary services and health
  care facilities

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Personal Tools to Bring to This Relationship

• Enthusiasm
• Likeability (God-given or learned)
• Friendly manner (smile, eye contact, etc.)
• Confidence (positive can do attitude)
• Honesty and integrity
• Compassion
• Competence
• Humility

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One of the essential qualities of the clinician
is interest in humanity, the secret of the care
of the patient is in caring for the patient.

• Dr. Francis W. PeabodyLandmark ArticleJAMA
  192788877-882

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Communication
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Three Methods of Communication

• What is said
• Body language
• How it is said (para language)

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Barriers to Listening

• Hop, skip, jump listening
• Excessive note taking
• Prematurely interrupting the patient
• Loss of eye contact
• Emotionally reacting to the patient
• Unnecessary interruptions

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Listening, not imitation, is the sincerest form
of flattery. Listening is unspoken caring.

• Sir William Osler

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Proper use of the patients history and physical
exam
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Patient Encounter Habits

• Enter the room with a smile and eye contact
• Call the patient by name
• Touch the patient handshake, touch on the
  shoulder, arm, etc. (remember you have only one
  opportunity to make a good first impression)

• Always sit down - if possible be at or below the
  eye level of the patient
• Lean forward (denotes interest)
• Listen actively and intently
• Place a mental frame around the patient - the
  entire patient
• Be present - your total thought and focus must be
  on the patient

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The Examination Process

• Have a chaperone present- when appropriate
• Make sure the patient is properly draped
• Find something on which to compliment the patient
  (beautiful eyes, contagious smile, etc.)
• Explain to the patient what to expect during the
  exam
• After the exam, involve the family if possible
  (lessens communication mistakes)
• Explain in laymens terms your findings and your
  action plan (all patients want to know the plan
  for them)
• Write down instructions for tests, medications,
  follow-up visits, etc.
• Ask if there are any more questions
• On the first visit, thank the patient for
  allowing you to participate in her care

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THE ART OF MEDICINE

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Learning to apply your knowledge and skills in
caring for the patient
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Proper use of the ancillary services and health
care facilities(cost-effective practices)
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Goals should be to practice -

• Competent
• Compassionate
• Cost-effective
• Convenient

Healthcare
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• No greater opportunity, responsibility or
  obligation can fall to the lot of a human being
  than to become a physician. In the care of the
  suffering he needs technical skill, scientific
  knowledge and human understanding. He who uses
  these with courage, with humility and with wisdom
  will provide a unique service for his fellow man,
  and will build an enduring edifice of character
  within himself. The physician should ask of his
  destiny no more than this he should be content
  with no less.

Dr. T. R. Harrison
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Challenges in the System

• Cost
• Access
• Quality
• Professional liability

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Paucity of Entry Points into Health Care System

• Internal medicine residents pursuing
  sub-specialties

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Once in the System

• Increasing complaints about
• waiting to get into the office
• waiting after getting into the office
• waiting for important test results

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Physicians Concerns

• Loss of control of the clinical practice
• Declining financial incomes
• Having to see too many patients
• Professional liability bear
• Balancing personal and professional life

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THE ART OF MEDICINE

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Recommended Reaction by the Independent Clinician

• Apply the tenets of the art of medicine
• Focus on emotional income as well as financial
  income
• Build long-lasting relationships with your
  patients (happy patients will attach to you as
  will barnacles to a ship)
• Create a culture of happiness in the office and
  hospital

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Look up and not down look out and not in
look forward and not back, and lend a hand.

• Edward Everett Hale

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THE ART OF MEDICINE

• The Key to a Happy and Productive Professional
  Life as a Clinician

Ronald E. Henderson, MD Professor Dept.
Obstetrics and Gynecology
Medicine ConferenceAugust 8, 2006