DOES THE ART OF MEDICINE DISAPPEAR WHEN DEALING WITH DIFFICULT PATIENTS? PART 1

ESTABLISHING MY OWN PRIVATE PRACTICE

The above question pertains two additional and poorly understood concepts and questions:

1 – What is Medical Art?

2 – Which patients are considered as “difficult patients”?

Before I try to answer these questions, I would like to talk about how I setup my own private practice of gastroenterology that I loved.

After finishing my gastroenterology training, I hesitated for a while on whether I should stay in academia or go to private practice of medicine. After a period of serious thinking and deliberation, I decided that academic medicine and research were too rigid and methodical for me. I would like to have more human’s contact, more freedom, and the opportunity for self-expression. I decided to go into private practice to become my own boss, so that I can pick and choose my patients, my time and place to establish a private practice that is compatible with my personality, and my understanding of how medical care should be.

I was inspired with three wisemen and with their ‘words of wisdom’ in setting up my unique private practice. These wisemen were Confucius, Sokrates and Osler.

Confucius (551 – 421 BC) if 5th century BC, renown Chinese doctor and philosopher said, “chose a job you love, you don’t have to work the rest of your life.” He also said,” I hear and I forget, I see and I remember, I do and I understand.”

Sokrates (469 -399 BC) ancient Greek philosopher and teacher, who is considered the father of Socratic Dialectic Teaching and modern thinking said, “I cannot teach anything to anybody, unless I teach them first how to think. Thinking, especially critical thinking by reasoning, and establishing a dialog with your students, encouraging their participation in learning process is the foundation of learning by thinking.” Socrates also said, “nothing is so well learned as that which is discovered by personal experiences.”

Milliam Osler (1859 – 1919) Canadian physician, educator, professor, historian, cofounder of Johns Hopkins hospital, who is considered the father of clinical medicine, and who took the teaching of clinical medicine from the conference rooms to the bed side of the patient. Osler said, “listen to your patients carefully he/she is trying to tell you the diagnosis.” Osler also said, “the practice of medicine is an art not a trade, a calling, not a business. A calling in which your heart will be exercised equally with your head.”

With all this knowledge. and ideas in mind, setting up my own private practice of gastroenterology was not that difficult. I thought that since the practice of medicine is not a small business (as claimed by some) business rules of making as much profit as possible does not apply to me. If I make a comfortable living, support may family and pay my bills.

By being my own boss, select the place, time, and my patients so that my practice would reflect my personality characteristics, my understanding, and intellectual interests. And I could remain loyal to moral and ethical reasoning of practice of medicine. As a compassionate and caring person. I could apply my theoretical book knowledge to my patients, and learn from them experience generated real medical knowledge, always combine, and keep up with the art and science of medicine.

Modern scientific research has shown that only experience generated knowledge are real, and makes permanent neuro-anatomical changes in the neural networks of the brain, remain vividly, in long term memory, and influence the thinking and behaviors a well-educated person.

Furthermore, I thought as a doctor, I should listen my patients carefully, not only use my thinking and my brain energy only to diagnose the disease, but also use my heart to see the sick person, and try to help him. And answer all his/her questions and concerns.