Following up with some previous article posts, I’d like to expand on the idea of the doctor not just as someone who gives medicine, but someone who is medicine.
There is a two-fold promise implicit in the oath we take to become stewards of medicine. First, medical students swear to safeguard the profession on the vocational level, to preserve its tenets as it was originally decreed in the Hippocratic Oath. The second promise is the more interesting one. It requires that the physician become a vehicle of medicine, bestowing a medicinal effect onto her patients simply by being their doctor. This promise cannot come to fruition without appreciating that the true subject of medicine is not the disease but the patient. Each patient is invariably more than his present illness. He is a dynamic individual with a complex psyche, spectrum of emotions, and irrevocable personal history. Ignoring this as the core principle in effective medical practice undermines the essence of healthcare altogether.
The physician must guide patients through illness and recovery with a spirit of guardianship. In effect, the physician’s presence and relationship with the patient can become a kind of medication. We typically conceive of physicians’ treatment as efficient—a specific problem is identified, quickly diagnosed, and immediately resolved by prescription. But for an adept doctor, there exists an entirely different approach through which she can put her patients at ease, consider the patient’s mental and social history in treatment options, and shepherd them through the often terrifying experience of illness or of being in a hospital. The crux of the matter is that if the physician does not fully actualize her role as steward, she may fail to uphold her responsibilities toward patients and effectively lose her agency as healer.
Very simply, people go to the doctor because they are sick. They seek treatment because the complex process of maintaining their health has surpassed a threshold beyond which they cannot remedy on their own. The experience of having one’s body fail can be deeply traumatic. The decision to see one’s doctor, then, becomes something of a treatment in itself. Patients go to the doctor to seek alleviation, to mitigate their concerns with her explanations, to feel comfort from the palpation of her hands on their bodies. In this intimate relationship the patient no longer regards the physician as someone who does medicine, but someone who is medicine. The simple presence and attention instills within the patient a sense of reparation and relief. Still, people do not visit the doctor because they believe she is the cure, it is this actual relationship they seek; the medical interaction reassures us of our humanity and encourages us to endure through illness.
The next generation of physicians will undergo many challenges. A larger percentage of the population will be elderly and require care. Medical advancements will continue to develop rapidly. If we are to safeguard the profession of medicine we must revolve all healthcare efforts around the relationship between the patient and physician, because it is there that genuine healing resides. A renewed approach to medicine will ensure that biotechnology serves to enhance, not replace, the interaction between patient and doctor, and that this focus be reestablished in medical training.
As we come to a close this semester, let us not forget that the purpose of our education comprises more than just our knowledge; becoming doctors of medicine is exactly that; we are training to become medicine.
Christopher Salib, MSII
Editor-in-Chief, The Pulse