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.
Indeed, 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
Doctors by design
We all have stories about how we came to be doctors … but have we ever stopped to consider that we may be doctors by design? That our path may be prepared for us and that there is a plan for us that unfolds, sometimes in spite of our ‘selves’ rather than because of us?
Blind spots
We all have blind spots in our fields of vision, that can be mapped. This is a known fact in Medicine. What is not so well known or accepted is that we as doctors also have blind spots, not just in our visual fields but in our perceptions of life, that are influenced by our beliefs and ideals.
Sitting is satisfying, for doctors and for patients
I recently read an article (1) suggesting that sitting is satisfying, for doctors and for patients. The article stated that: “Sitting at a patient's...
Life as a country doctor
I attended a function last night in the town where I live and work, at which we hosted our young doctors and talked to...
When Medicine is a ‘Calling’
What do we mean when we say that medicine is a ‘calling’? And what implications does that have for the way we practice medicine and the way we live our lives?
The Art of Mentoring
Medicine is an apprenticeship system and like all such systems, works best if the masters train their apprentices not just in a functional way, but with a deep level of care, as people and as colleagues. We now call this process mentoring.
Relationships and medicine
Medicine is all about relationships. It is about caring for people, after all. So why do we place so little focus on this vital element of our profession?
Why do doctors smoke?
We all know the harms of smoking and in fact there is nothing healing about it, so why do doctors smoke?
When we lose someone we love
We don’t talk about it in Medicine much, when we lose someone we love. Doctors are no strangers to death and as part of our training, we are taught to toughen up, take things in our stride and become seemingly inured to death.
The Pill
Of all the many drugs on the market, there is only one pill known as ‘The Pill’. The Pill is a combination of synthetic female hormones – oestrogen and progesterone – used to mimic pregnancy and suppress female ovulation and thereby fertility, reducing the chance of unwanted pregnancy.
Making the choice
My experience so far with medical specialist training programmes and making the choice about which one to do, reminds me of the journey Frodo takes in the Lord of the Rings movie.
National Physician Suicide Awareness Day 2021: With Gratitude to the Feists
A beautiful blog by Dr Michael Myers, on the recent National Physician Suicide Awareness Day and the great work being done by Jennifer and Corey Feist, founders of the Dr Lorna Breen Heroes Foundation, one of the missions of which is “We envision a world where seeking mental health services is universally viewed as a sign of strength for health care professionals.”.
True Resilience
The key to developing true resilience is to care for ourselves and restore our sense of innate wholeness and worth, learning to love and appreciate ourselves just for who we are and to honour our innate sensitivity, letting the wisdom of our body guide our way, each and every day.
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...