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At times I feel like I'm practicing medicine in a tunnel, one where the only way out is to prescribe pharmaceuticals that have gone through double-blind, placebo-controlled trials. Modern medicine has brought us many wonderful advances -- and, believe me, I understand that controlled trials are important -- but what about the art of medicine?
Have we forgotten about the many modes of healing at our fingertips? And what about the individuality of each patient? The reality is that what happens in a laboratory or in a clinical trial is not always what we see in practice every day. Besides, the data we read in scientific journals may not even be reported accurately. I recently read Sherri Tenpenny, M.D.'s blog on fraudulent medical research, where she discusses researchers making up results and publishing them in prestigious medical journals. Yet we base so much medical advice on what this research reports.
I'm charging all of us to demand more from our health care providers. And for those of us working in the health care industry, step back for a moment and take an inventory of all that you know, inside and outside medical research. What have your patients taught you? What have you learned in your life? What studies have you read and put into practice that have made a difference? There is wisdom here that we've overlooked, and I think it's about time we come back to our black bags, our medicine chests and apothecaries, and take an inventory of all the tools we've been collecting.
19 hours ago (12:06 PM)
Listening, treating the whole person, and so on are ideal. But one major problem with medicine surely is that rather than losing its status as "art", much of it is barely even "science" yet. It’s amazing that evidence-based medicine has taken so long to prevail against practitioners’ anecdotal "wisdom" (so-called).
18 hours ago (12:51 PM)
What is happening is that medicine is a ruthless business. The profit is not in taking care of patients, but in selling unnecessary medications on behalf of megapharma, and in third party running of health insurance. The profit model being that one gets better, only worse, needing ever more services -
17 hours ago (1:32 PM)
The Art of Medicine was first wounded by the over-reliance on technology as taught in medical schools (have you asked a young resident to do a differential diagnosis lately?). Then the mortal wound came with the so called "evidence-based" protocols, which are nothing more than a Carte Blanche for the insurance companies to deny treatments.
1 hour ago (5:28 AM)
I think the author did a good job of maintaining the line between modern medicine and alternatives, you did not. You don’t have one shred of evidence for your assertions, and personally I find them ridiculous. Your notions about spirit can never be incorporated into science unless they are shown to exist. Good luck with that one.
16 hours ago (2:35 PM)
Thank you for bringing up the lost art of medicine and the natural wisdom of the past. The most glaring omission is neglecting the spiritual aspects of a human being in medicine, and in the functional medicine matrix. The invisible inner spiritual self is, in my estimation, the biggest part of our being, and the most ignored in our current external locus of focus. We have forgotten where the power for healing really resides. Removing the Spirit of God from medicine or healing arts is like draining a lake one teaspoon at a time, or trying to cut down a tree with a kitchen knife. The greatest healer of all time was Jesus and he never healed the same way twice. He listened for higher guidance and used the Spirit of God for power. Just think how health care could change if the Spirit was added to scientific knowledge, and each patient was looked at as a unique individual and given personalized medicine based on science AND higher guidance and wisdom. http://www.newheavenonearth.wordpress.com
16 hours ago (2:54 PM)
Art is subjective and has no standards as to outcome. There’s that.
11 hours ago (7:47 PM)
Very interesting thread – my only comment would be that menopause, along with women’s health and bodies (especially our reproductive organs) have been not just medicalised, but pathologised, for centuries. Male body = the norm, female body = deviation, has been the attitude of medical teaching for far too long. The HRT business is just part of that tradition.
12 hours ago (7:09 PM)
The comment was about self-referral as a cash cow. Don’t you know a Neurologist, Neurosurgeon, Cardiologist, or Orthopedic who owns his/her own equipment? They bill for both components, professional and technical. Back pain: you get the plain films, then the CT, then the MRI and then the PT–all at the one-stop shop.
My father’s Cardiologist no longer sees patients in-house. Too busy doing cardiolite stress test at the office. My own Neuro expects me to have a MRI at his facility. One doc has a one-year fellowship in faux Radiology—the rest have no fellowships—just the MD. That’s who they expect me to have interpret my exams!. My Neuro can look at it after the trained professional does. Four eyes are better than two—but if I only get two they had better be some who has years of training and thousands of exams under his/her belt.
This is becoming more and more prevalent and needs to stop. Recent studies have shown no better care and only an increase in cost—not to mention radiation.
So, you are correct, if you don’t own the equipment and refer to a Radiologist—you get nothing in cash—but at least you get a pro. And in my mind, a physician who refers patients’ to these one-stop shops is doing patients a disservice. Can you be sure the patient needs the exam or the repeat exam—or if the bill from GE came in.
13 hours ago (6:12 PM)
You have a nice understanding of evidence-based medicine and protocols...but I do take issue with your "complete embracing of exams to bring in the cash." We Docs (in most specialties except radiology) get paid NOTHING…for any type of exam, except the good old fashion physical. Problem is, if anything is missed and WOULD HAVE been picked up by a CT, "poof," one is sued for malpractice and negligence. A career is over, whether or not you are right or wrong. The "art" unfortunately left when defensive medicine and our disgusting system came to power.
15 hours ago (3:17 PM)
The "art" was removed a long time ago. Physicians are trained to interpret exams and tests, and have abdicated their art to device, equipment and drug companies. Who can forget the compliancy in the HRT scenario? Evidence-based reviews of trials showed the problems–but menopause was "medicalized" along with osteoporosis. Year after year–breast cancer after breast cancer—still denial. And the cash flowed.
Evidence based medicine is not the problem and neither are protocols. Many stroke patients used to leave the hospital without cholesterol or anti-clotting therapy? Protocols make sure the MRI gets done so TPA can be within the three hour window. Lives are saved with routine.
Evidence –based medicine tells us lots of drugs don’t work—or if they do work poorly. Read the Cochrane Review. Most of the reviews say that more study is needed; the endpoints measured in the trial were of no value, or not the same measures, not enough time or patients studied. But your doc says—you have to take the drug for life—even if there is only a 30% chance it works. Oh, and by the way, the patent keeps getting extended, so no generic and the price goes up 10-15% a year.
And then there is the little problem of self-referral. The complete embracing of exams to bring in the cash. 35 years ago, we used to say medicine was an art and a science. The art is gone, and the science is often times just well-funded PR.
11 hours ago (7:19 PM)
The "art of medicine" died with the advent of the PPO. Back when physicians had the ability to practice medicine based on their own knowledge and experience it was an art. Third party payers, and their accountants have turned the art of medicine into the science of what is most cost-effective with the mandatory application of treatment algorithms.
3 minutes ago (6:41 AM)
The intriguing question raised here is whether people who are clear on their professional values can overcome forces that push towards mediocrity. Job burnout in health care says more about value conflicts between professionals v management systems than it says about chronic exhaustion (http://171.66.125.180/content/55/12/1224.full.pdf­
. The problem is a challenge but it will require a shift in power and responsibility to come about.
http://www.workengagement.com/crew
22 hours ago (10:45 AM)
Even though I pay for my insurance, I feel like it is the medieval period again. That the very wealthy get much better quality of care, not because they pay extra for concierge type visits, but simply due to politics with a small *p. And the rest of us get the dregs of the medical community, even though we also pay and pay mightily through the nose. And it has been that way for a very long time. I don’t see this as a caring profession any more. I see this as a high dollar boutique industry. For me, a blue collar person, going to the doctor is like buying an air brushed tee shirt at the mall Kiosk. For someone wealthy, its like paying golf with a judge or going to a spa. Those are all remarkable departures in concepts.
23 hours ago (9:52 AM)
I agree with you completely. My choice to spend more time with my patients means that I see less patients and make significantly less money than my counterparts. But I often spend time in my office explaining to patients what their other doctors have done and discussing the pharmaceuticals other people have prescribed. It’s unfortunate that our system has become what it is. As long as insurance companies determine what we charge and what we can do/prescribe for a patient, it will be this way. When we take the profit margin off insurance companies, we stand a chance of seeing real change.
22 hours ago (10:41 AM)
A simple stool test for H. Pyloria and the stomach cancer might have been avoided. I started out with acid problems coming out both ends {and I will leave it at that} I had to go look the symptoms up myself because my doctor said I should take Acid Blockers and probably would for life–her reason for my condition? I am getting older. I found out that this bacteria causes acid reflux and a lot of other symptoms and often leads to stomach cancer. I had to get in her face to get her to give me the test. I had it, I got treatment, and I am better. I am glad I didn’t start taking those acid blockers. The body becomes dependent on them after a while. Convenient for drug companies because they are expensive, but bad for me. I thought she was nice, but she is intellectually lazy–this doctor and I take that personally when such laziness impacts my health to that degree. That is just 1 story.
07:50 AM on 7/11/2011
I’d like to offer an apology to you and your family on behalf of my profession for what you have been through. I cannot certify your conclusion that most of us are interested only in money, but to even hint at such an attitude while caring for a patient is despicable. That said, it is important to distinguish between a "power trip" by an office manager refusing to make an appointment because of an outstanding bill and the physician’s attitude. It is also important to understand just how negative an impact all of the rhetoric and threats about reimbursement has had on the love of medicine that so many of us entered the profession with. None of this, of course, justifies what you’ve experienced, but perhaps it can help you to understand a little better. Peace!
06:26 AM on 7/11/2011
Most doctors are very similar to used car salesmen and politicians. They don’t care about the person, they only want the money.
My father died from stomach cancer on July 4, 2002. He saw three different doctors over an eight year period in Springfield, IL about stomach pains. He only received medications that masked the pain, but he always paid their bills. When he moved back to Ocala Florida in January 2002, tests never ordered in Springfield discovered the by then untreatable cancer. He died a very painful death from something the Ocala doctor said probably could have been treated had the Springfield doctors done their jobs.
My mother was diagnosed as terminal six months ago. I transport her to various doctor offices, the hospital, and pay the uncovered portion of her medical bills – about $3,500 a month. The doctors always make sure they get payment before treatment. Her PCP once refused to schedule her until I resolved an outstanding balance of $4.27. Money is obviously the main concern, not the patient.
She told me that before I retired from the army and began taking her to the appointments, she was treated disrespectfully by both her PCP and oncologist. I cannot help her medically, but I can ensure "medical professionals" treat her with concern and respect. I forcefully call them out if they do anything less. I’m sure they intensely dislike me, but it’s time medical practitioners re-learned how to treat patients like humans, not an income stream.
09:17 PM on 7/10/2011
Both you and Irish doc make valid points. I started taking care of HIV patients in the late 80′s and at the time, we had only 3 drugs. When one failed, the others didn’t work all that well. So my patients taught me a lot about alternative medicine..…herbs, macrobiotics, acupuncture, etc in search of a treatment. I was fortunate that I worked at an academic medical center at a time when quality and not productivity mattered. I could invest the time and look into alternatives without a financial penalty for lost revenue.
The only resolution to this sad state of being paid by productivity (squeezing 10 pounds into a 5 pound bag) will be changing the model to that which rewards good outcomes and not volume.
03:58 PM on 7/10/2011
I have to full heartedly agree here. The "Art" of medicine has slowly been pushed aside to facilitate financial institutions to the detriment of the doctor patient relationship. Physicians no longer trust their patients and patients no longer trust their doctors. The practice of medicine has gotten muddled with HIPPA requirements and midlevels to such a degree that people can’t use common sense anymore. I occasionally get to bridge the gap between my patients, myself, and the scientific realities of the fragile human condition, and when I do my job is helps me be a better person. Sadly this happens far to infrequently.
05:59 AM on 7/10/2011
It is lovely that a salaried NP (who really seems to come from the heart) wonders what happened to the art of medicine. Ask any open-minded, really committed doctor: she will say," I’m fighting for my art and my science tooth and nail, but there is no time for art in a 5-10 minute visit." As a sub-specialist, I am able to practice my art, as it seems you are as well.
I work with NPs (whom I value immensely), but I strongly feel that the precarious art is being destroyed by insurance companies, not faulty data (which after publication are picked apart in academic centers in weekly Journal Clubs), and certainly not your friend’s inability to give herbs. Yoga, sleep, eating healthy: wonderful AND scientifically proven. Unregulated FDA treatments: frightening (I’m sure you’ve rotated in a liver transplant ward).
01:14 PM on 7/10/2011
A great novel about the struggle between our internal ability to heal and the idea of healthcare/modern medicine is Ada, Legend of a Healer http://www.adaslegend.com. It is a girl empowering novel that has been found to be enjoyed by all, for the philosophy, the coming of age, and the beauty we all have within us.
I believe what you have said in this article should be heard by many more.
Yandor
21 hours ago (11:55 AM)
I worked with someone who had high BP and was pretty overweight and he also claimed he had Type 2 diabetes. He said he was treating the Type 2 himself….through diet. Based on what I saw him eating, it did not appear to me that that was the case.
22 hours ago (10:36 AM)
Yes, A surprising lack of personal responsibility in one’s health. Uhuh. Any other UFOs there Doc because I have heard that one before. Meanwhile I have to look up my own stuff and treat myself with alt medicines and supplements because I don’t have a script pad and all my doctors thus far have sucked.
03:51 PM on 7/10/2011
With all due respect ma’am, the art of medicine is alive and well…it refers to the fact that you can’t freat everyone with condition "x" the same way and expect perfect results. Everyone is different with different lives, diifferent medical conditions, and different abilities to follow advice. Experience of the provider enables one to recognize when to treat someone differently…algorithms can only get you so far.
If you think the art is dead because we don’t use herbals, meditation and such then you are nuts. What is wrong with medicine now is that it is ALL about numbers…you don’t get paid more for taking lots of time with patients, you get paid for seeing lots of patients. That is precisely why concierge practices are gaining. Also, there is an amazing lack of personal responsibility for ones own health. You can only do so much for the 300lb hypertensive with heart disease who smokes and eats like crap and doesn’t exercise.
04:04 PM on 7/10/2011
I hate to go to the vet
05:14 PM on 7/10/2011
" Overdosed America" The Broken Promise of American Medicine" by John Abramson MD.
Unfortunately, too many docs have become shills of Big Pharma. The majority of "diseases" that we treat are caused by a poor lifestyle and yet our default strategy is to prescribe pills that are palliative. Most of cardiology is like this. CAD can be prevented and reversed by a plant-based diet and yet very few cardiologists tell this to their patients. Rather, they would prefer to place stents and then create an iatrogenic coagulopathy by administrating aspirin and Plavix. Someday, a big class-action firm will put an end to this activity.
05:54 PM on 7/10/2011
Great point of view. Medicine is about caring for the person in all entirety. The business of medicine conflicts with this noble goal but we will always strive to practice medicine. This is why we went into the profession.
22 hours ago (10:34 AM)
I remember that bumpersticker: HMO = DOA
06:55 PM on 7/10/2011
The art of medicine died as soon as the first quesion asked when you set an appointment changed from "What is your problem?" to "What is your insurance?" and from seeing the doctor before paying for services to making payment prior to seeing the doctor. I would hazard a guess that the first question asked by Dr. Pick’s office is also the insurance question.
Other than military doctors (I kept catching bits of metal and other stuff with my body), almost all doctors I have encountered seem to specialize in walletectomies. Actually doing something for the patient is secondary to receipt of the wallet’s contents.
07:10 PM on 7/10/2011
Big Pharma, BigMedicine, BigFarming etc etc