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There is more to healing than the application of scientific knowledge.Explain this statement. What else is important in medicine

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Answer

Medicine is both a science and an art. It has a proud scientific basis;, the application of evidence based medicine and rigor of scientific logic but a consultation with a doctor often involves a lot more than making a diagnosis and treating.

The ‘art’ of medicine renders all appointments interesting and none routine. A good doctor-patient relationship and the development of trust is therapeutic in itself. Patients are much more likely to follow advice and treatment. We are familiar with the term ‘the doctor as the drug’. A doctor’s reassurance has been shown to reduce pain scores, panic attacks and other conditions even if no treatment is given. In General Practice, where patients are seen with many different conditions over a long period of time, even visits for minor conditions can augment an important  relationship where communication skills, sensitivity and empathy all play their part, often subconsciously.

I am reminded of the story of a team of management consultants who were asked to make efficiency savings for an orchestra. They saw that there were a number of violins all ‘doing the same job’ and cut the violins down to one. Then they started to look at other instruments. More and more cuts followed. At the end they had replaced the entire orchestra with a CD player – it did the same job and cost less didn’t it?  But of course something was lost!

Not everything that can be counted counts and not everything that counts can be counted (Albert Einstein). What do you think is meant by this statement?Give examples of things that count in medicine which cannot be counted. To what degree should they count?

This essay question and the one above are describing the importance  of subjective experience such as  ’the art of medicine’. You could do a similar answer for this question. 

He who conceals his disease cannot expect to be cured. Why would someone conceal their disease? How should a doctor handle this scenario? What is the most important ethical principle?

‘Denial is an important defence mechanism’. Patients may conceal their disease from a doctor for a number of reasons such as shyness, embarrassment and denial. Denial is one of the commonest reasons for the patient to hide a suspected disease. It may be an important coping mechanism.

The doctor needs to show great respect, empathy and sensitivity to win the patient’s confidence. Being non judgemental is an important principle in medical ethics. Gentle exploration of a patient’s symptoms and understanding should take place, preferably conversation should be patient led. At an early stage the doctor should regard building a rapport and gaining trust to be the most important process. However the doctor should inform the patient that nearly everything is easier to treat in its early stages. He should inform the patient that ‘his door is always open’ if he should wish to reconsider.

Beneficence must be balanced with autonomy. Patients often fear a power imbalance in the doctor-patient relationship and feel that they may be forced to do something they do not want. It must always be stressed that nothing will be done without their consent and they will be helped to make an informed judgement in all cases. Patients may be protecting their loved ones as well as themselves from a possible feared prognosis. As long as the patient has capacity the doctor should respect the patient’s views and try and understand their fears. Patients have the right not to know as well as to know about themselves. Autonomy in this situation is the most important principle.

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