The Practice of Medicine
The practice of medicine is an art as well as a science. For a long time now we have largely focussed on the science, and ignored the art, at the great expense of people, including ourselves.
Medicine used to care for the whole person, but our focus has been progressively reduced, and we have become more and more focussed on the parts, sometimes at the expense of the whole.
Evidence-based medicine has come to be regarded and taught as the ‘gold standard’ of practice and we have been asked to apply it to all people and all cases.
Evidence-based medicine has an important role to play in our practice, but it is based on population studies, and while it may give us a big picture on which to base our decisions, it does not apply in every single case. Indeed, applying it indiscriminately can cause great harm, for people are unique individuals, who do not always fit into evidence-based sized boxes.
This is the art of medicine – knowing when to apply the evidence; knowing when, having applied it, it is clearly not working for this particular person and a different approach is called for; and knowing that the evidence is often limited to the physical, when we are more than merely physical.
Read moreIndeed, there are cracks appearing in evidence-based medicine. It is increasingly being shown that some, if not much of the evidence is flawed, that studies are often not repeatable; even that studies have been corrupted because of the vested interests of those paying for the research.
Evidence-based medicine is important, but it is not everything in its current form, because it largely ignores the evidence of the body and the being inside the body. The art of medicine is time honoured … listening to our patients, observing them, examining them as a whole in the context of work, family, community, society, all of which can influence health and wellbeing.
Bringing this art together with true science – which includes the art of observing things as they truly are, not as we would like them to be – offers us a way forward, to become true practitioners of medicine again.
Latest Articles on the Practice of Medicine
A Wellbeing Charter for Doctors
The Royal Australasian College of Surgeons (RACS) in conjunction with several other medical colleges and more to come, has just released a Wellbeing Charter for Doctors. This is a great first step in acknowledging the importance of self-care in healthcare professionals and the need for this care to be a shared responsibility for all of us.
Standards
We all have standards. They may not always be the same standards, but we all have them. Values that we hold dear, points of truth we will not compromise, a way of living that we hold as sacred.
Invoking Caste: Why Physicians With Psychiatric Illness Are Shunned
American medicine has a checkered history in its welcoming of physicians who are black, women, physically disabled, LGBT, to name a few. As a specialist in physician health and a 50-year career of treating physicians,1 I would like to add another group that has struggled for acceptance—physicians who have suffered a psychiatric illness. I argue that caste may be the reason.
It Is Never Too Late
My name is Evan Haines*. I’m writing you because I believe my mother, who, sadly, committed suicide in 1989, was under your care. I remember your name, and that she always thought very highly of you.
How Well-Intentioned Advice Is Suppressing the Doctors of Tomorrow
Read this blog by renowned psychiatrist Dr Michael Myers on how well-intentioned advice is suppressing the doctors of tomorrow
A Tip of the Hat to Medical School Applicants: Chipping Away at Stigma
One dimension of my daily work that I really enjoy is interviewing applicants to medical school. I’m often tasked with interviewing a specific group of applicants, the ones who openly write that they have suffered from mental health symptoms in the past.
Personal sustainability
We hear a lot about sustainability these days in terms of the economy, the environment, and society, but what is personal sustainability when it comes to us, the people who make up that society and determine what sustainability is?
Heart-Centred Medicine: A Return to Ancient Wisdom
Would a return to an ‘innermost’ way of life, a heart-centred intelligence and awareness, be something we as physicians, could consider?
Dr. Michael Myers on Becoming a Doctors’ Doctor
In this podcast, Michael Myers, MD, and John Budin, MD, discuss Dr. Myers' recent book Becoming a Doctors' Doctor: A Memoir, as well as how the COVID-19 pandemic is helping medical professionals admit their vulnerabilities and steps clinicians can take when they have colleagues who may need professional help.
Masks: are you wearing one?
It’s 2020. The Year of the Mask. Whether you are a medical professional or not, you will have been asked to wear them, discern their worth, determine which type is best for you, consider their real purpose and deliberate on where you stand with respect to the health benefits they may offer you personally or the population as a whole.
Diary of a Doctor’s Wife
These moments have taught me to become adaptable and go with the flow. My own solid rhythm is paramount these days, otherwise disappointment and frustration come knocking. Trust me, I have tried to control it and wanted it to be another way and it doesn’t work.
Remembering Dr. Lorna Breen on National Physician Suicide Awareness Day
September 17, 2020, marked the third annual National Physician Suicide Awareness Day. This is a day to remember physicians who have taken their own lives.
Lighthouse
We are each and every one of us a lighthouse, designed to shine bright and light the way for others. It is for us to let that light out and shine in full, reminding everyone we meet that they too are that light, for this light lives inside us all, and we are all here to shine and light the way home together.
Giving Physicians a Private Place to Turn
For several months, I have been following news about the Physician Support Line launched by Dr. Mona Masood, a Philadelphia psychiatrist (1,2). As a...
Being married to a doctor
What is it like, being married to a doctor? My gorgeous wife is an eye surgeon; we have been together for 16 years and...
A Dance
My husband often works at the hospital at night and so as the saying goes, we are two ships passing, living a dance where...
Age is no barrier to medicine
I have come to medicine later in life. I was 32 when the impulse to study medicine came, 34 when I sat the entrance...
Coronavirus and contagion: what are we passing on?
My husband works as a doctor in a hospital so I am frequently reminded of the constant demand health professionals are under. On a...
Coronavirus: isolate physically, but don’t socially isolate
We are in the midst of a coronavirus pandemic, and being told to socially isolate if we have travelled overseas recently, been in contact...
A Doctor’s Wife
I met a beautiful man several years ago and we fell in love instantly. He was not working as a doctor when we met...
Why bring love into medicine?
The words love and medicine are rarely used in the same sentence. Not many people say they love taking their medicine. Not many doctors...
This is Going to Hurt
One of the joys of having a Christmas/New Year break is having the time and space to read. I recently read a book called:...
Harnessing Grief Into Action: A Tribute to a Remarkable Woman
Dr. Sangeeta Mahajan is a remarkable woman. She is a consultant anesthetist at Guy’s and St Thomas’ NHS Foundation Trust in London, England. She...
Mentors, Sponsors and Gender Inequity
I recently attended a conference and heard a presentation delivered to female surgeons which addressed the subject of mentors, sponsors and gender inequity in...
From being bored to enriching life
I work as an eye doctor and people sometimes ask me: Don’t you get bored with what you do? Well the answer is: No,...
Why half our patients don’t tell their doctors life-threatening details
I recently read an article stating that nearly half of patients who were surveyed online admitted they don’t tell doctors potentially life-threatening details of...
The Fragmentation of Medicine
I have witnessed many changes within medicine over the last 30 years – one of which has been the increasing fragmentation of medicine despite...
The Key to Orienting Incoming Residents and Fellows
I recently had a chance to speak to State University of New York (SUNY) Downstate’s incoming residents and fellows about well-being and self-care.These women...
Are you trapped in time, or surrendered to space?
I used to live life ruled by time. I was not a very obedient subject, and was always running late, but it ruled me,...
Falling in and out of love with medicine
I loved studying medicine as a medical student. I was so curious to know how the body worked – how this bit interacted with...