The science of medicine continues to expand rapidly, and this is obviously good for humanity. The art of medicine, on the other hand, has been largely forgotten. This skill is the basis of the time-honored physician-patient relationship and is an important aspect of good patient care. So why have so many physicians forgotten this basic skill? Why would a caring physician disregard any expertise that would benefit his patient?

In today’s atmosphere of third-party payers, physicians are buried under excessive paperwork, they’re besieged by malpractice attorneys, and if they’re surgeons, their malpractice insurance premiums are often astronomical. Physicians find it difficult to incorporate all of their duties into an eight-hour day so they work longer hours. This makes them seem hurried and irritable. Patients pick up on this and feel the doctor is callous, uncaring, or worse, arrogant.  

 Because the insurance company is responsible for most, if not all, of the patient’s bill, patients only go to doctors who are covered under their plan. This makes the physicians feel their patients are disloyal. Besides that, the insurance companies insist on referring to physicians as health care providers thereby clumping them in with anyone who interacts with a patient. This term ignores the fact that many physicians have undergone fifteen or more years of training and would prefer to be referred to by their correct title. 

The dissatisfaction that physicians feel today can lead to poor patient care. Instead of taking their frustration out on the third-party payers, many doctors take it out on their patients. My advice to these doctors is this: The patient is not the enemy. If the physician wants to vent his anger, he should direct his angst where it belongs, at those who stand between the doctor and his patient and constantly attempt to micromanage the patient’s care.

So what is the art of medicine and what does it have to do with any of this? It is a multifaceted approach to patient care that takes into consideration the patient’s emotional as well as his physical state of being. All good doctors recognize the role that emotions play in an individual’s illness. In addition, the patient’s interest must be placed above all others. If the doctor always does what’s best for the patient, he never has to be concerned about his ethics. Therefore, the patient’s interest must come before that of the doctor, the insurance company, the hospital, or the surgery center. This is particularly true if the surgeon owns a financial interest in the surgery center.

In general, patients want to know several things when they visit a doctor’s office. These are: What is wrong with me? What diagnostic tests will I need? When will I get the results of the tests? Will the results be explained to me? Will I need surgery? If so, how much is it going to cost? How long will I be out of work?

So when interacting with a patient for the first time, the physician must keep these common questions in the back of his mind. The doctor must explain in easy-to-understand language the diagnostic studies that have been ordered and any possible side effects that might occur. It’s important for the patient to know why the studies are being recommended. The time span between when the studies are completed and a return office visit should be as short as possible. The patient wants to know the results and doesn’t want to wait too long for an answer. Most often the patient is anxious and very concerned.

One of the most important aspects of good patient care is keeping the patient fully informed. If the physician uses a variety of methods to inform the patient, seldom will the patient have questions. When he or she does, the physician must set aside time to answer any and all questions that arise. The physician should be seated when explaining things to a patient. It puts the patient at ease.

If surgery is to be considered, the procedure should be discussed in detail covering all the possible benefits and complications. Ideally, this should be done in person. However, there are several ways a surgeon can accomplish this in a busy practice. 

Camcorders are inexpensive, and there are easy-to-use editing programs available to allow the doctor to produce his own DVDs.  Sitting at a desk in front of the camcorder, the doctor should carefully explain each procedure using illustrations to emphasize how the surgery is to be performed as well as all the possible known complications. The patient needs to understand the complications because if one occurs, he will know what to expect. After the patient has viewed the DVD with family members, the surgeon should see them and answer any questions they might have. The patient should also be given a printed brochure that further explains what the surgeon covered on the DVD. With this approach, the surgeon seldom has to elaborate. Not only is this helpful for the patient, but it saves the doctor valuable time.

When explaining a grave illness or a complicated surgical procedure, the doctor should be honest but should not unduly frighten the patient. There are ways of explaining terrible situations in a manner that is not threatening. When a surgeon is explaining a surgical procedure, the surgeon must be realistic in what results he promises. If patients expect more than is reasonable, they will be disappointed with their result. This is the type of patient who is prone to sue the surgeon. As protection for the surgeon, the patient should be asked to sign a statement stating that the individual has viewed the DVD and brochure and has had questions answered.

A large part of any medical practice entails the diagnosis and treatment of complicated diseases. Take diabetes for instance. There are many things the newly diagnosed patient must know about the disease including weight control, elimination of sugar from their diet, the dangers of diabetic or insulin-induced coma, and countless other nuances associated with this complicated problem.  It’s important that the individual understand the underlying etiology and the rationale for treatment. It may take from thirty-five minutes to an hour to fully explain this in detail. There is no way a busy physician can allot this much time to each patient. A physician who understands time management will have a nurse spend time with the patient or prepare a DVD of him explaining everything the patient needs to know.  Written literature is also important, and the patient can take this home to study later.

When individuals are not feeling well and are anxious about their health, they are often frightened. Most have no idea what lies ahead of them. Many times physicians and nurses seem indifferent to the anxiety expressed by patients. Many doctors, particularly young ones, have never suffered anything worse than a head cold or an episode of influenza. If all physicians and nurses experienced a serious illness early in their careers, it would make them more compassionate toward their patients.

The physician should take time to listen to patients. Studies have shown that during the initial interview with a patient, the average doctor interrupts the patient’s story within the first seventeen seconds. This frustrates the patient. Doctors want a chronological history. Unfortunately, most patients don’t relate their symptoms in chronological order. They wander around, thinking of things as they pop into their heads. This frustrates the doctor.

In the current atmosphere in which physicians practice medicine, there is constant fear of a malpractice suit. In general, people don’t sue their friends. It’s up to the doctor to establish the initial relationship. If the physician appears aloof, disinterested, too busy, or impassionate, the patient isn’t going to feel close to the doctor or trust him. It is extremely important that a patient trust and like the doctor. And patients know when they’re being lied to or misled. They can sense when a physician is insincere.

All successful physicians from time to time run late in the office. It infuriates patients when they are forced to wait an hour or more to see their doctor. The smart physician will attempt to defuse this anger by saying something like, “Several patients before you needed my time and attention. You can be assured I’ll give you the same courtesy.”

When a patient is in the hospital, the good physician/surgeon makes rounds twice a day. That requires a few minutes at the foot of the patient’s bed going over the chart and answering questions. This can be done in three to five minutes. During these visits it’s permissible for the physician to stand. Patients know that doctors have more than one patient in the hospital and that they’re busy.

On the day of discharge, however, the routine should be different. The doctor should pull up a chair and sit down. Then he should say, “I’ll sit here as long as it takes to answer your questions.” The fact that the doctor has taken a seat tells the patient that the doctor has set aside that time for him only, and is not going to rush off to see someone else. If the doctor has prepared the patient properly, the visit will still take less than five minutes, but the patient will feel well served.

Any surgeon who states that he never has surgical complications is not being honest. Even the best surgeons have them. If the patient has been fully informed, that patient will accept the fact and do the best he can to endure the problem. The caring surgeon will say something like, “We discussed this possibility before surgery. I’m sorry the complication occurred and I will help you through this difficult situation.”

There are several intracranial procedures that can produce a temporary facial nerve weakness or paralysis. The facial nerve supplies the muscles of the face and is responsible for an individual’s smile, his wink, etc. Imagine how frightened a person would be if he woke up in the recovery room with a facial paralysis and hadn’t been told of that possibility. His first thought would be that he’d suffered a stroke. The well- informed patient would know immediately what had occurred, and most patients would not be frightened.

Following a surgical complication, instead of making rounds twice a day, the compassionate surgeon will do so four or more times. This lets the patient and family know the doctor is on top of the situation and is concerned about their well-being. In difficult or unusual cases, the secure physician will suggest a second opinion before the patient or family asks for one.

What do people do when they meet a stranger? They shake hands. Touch is a part of human communication. Successful physicians touch their patients respectfully. It might be a simple pat on the shoulder, but it lets the patient feel connected to the doctor in a physical way.

So why is the art of medicine important? It establishes the time-honored physician-patient relationship. The patient will have respect and confidence in his physician and will trust him. Patients will have a positive attitude going into surgery and accept a complication should one occur. Most of the time, they will not consider a malpractice suit because of a complication.

One of the most important results of the art of medicine is that patients do better and get well faster. That’s because they feel they’re in competent hands and they trust their doctor.

If the doctor-patient relationship is strong, patients will remain loyal to their physician and may even fight the insurance company in their doctor’s behalf. Not only that, but they will refer their friends and family members to their doctor. The most secure practice a physician can develop is one that is patient based. Even in today’s practice atmosphere, happy patients can build a solid practice for a caring and compassionate physician.

While the art of medicine may sound archaic and unscientific, nothing could be farther from the truth. All physicians recognize the part that emotions play in the lives of their patients. Anxiety alone accounts for a huge number of office visits. The doctor who fails to recognize this basic fact is doing an injustice to his patient.

In years past, people trusted their doctors and were very loyal to them. The ironic thing is that most of the time these physicians didn’t have diagnostic tools, sophisticated medicines, or surgical procedures to offer their patients. Now, with modern medicine’s many advances, the doctor has a lot to offer. In today’s medical atmosphere, it’s sad to realize that many patients don’t trust their physicians or even like them.

If more doctors practiced the art of medicine, would that make a difference? You bet it would. It goes back to that simple axiom: treat people with respect and they’ll reciprocate. And the “Malpractice Crisis” gripping this country would eventually become a moot issue.

Mike Glasscock