Have you ever wondered about the symbol of medicine, the caduceus? It’s two serpents entwined on a staff. Rooted in Greek and Roman mythology, one snake is Knowledge and the other isWisdom. According to legend, Hermes (messenger of the other gods as well as the god of science, eloquence, and cunning) found the two snakes writhing angrily in battle one day. Although not a herpetologist, he pacified the two and passed a staff between them. To this day, the concept of the ‘good physician’ combines a strong basic scientific knowledge with the wisdom to use this knowledge appropriately in caring for individual patients. It’s this second element, the wisdom, that transforms medicine from a rote discipline into an art when it is practiced well.
In a lecture to Johns Hopkins Medical School in November 1984, Canadian novelist Robertson Davies eloquently summarized, “. . .Wisdom is what makes [the doctor] look not at the disease, but at the bearer of the disease. It is what creates the link that united the healer with his patient, and the exercise of which makes him a true physician, a true healer, a true child of Hermes. It is Wisdom that tells the physician how to make the patient a partner in his own cure. Instead of calling them Knowledge and Wisdom, let us call them Science and Humanism.” Basically, each of us seeks a personal physician who will listen to us, be kind and compassionate, and have the knowledge to know which treatment(s) will logically prove of greatest benefit. It’s that blend of educated professional and caring friend that instills confidence while simultaneously generating comfort. In today’s changing health care climate, the doctor-patient relationship faces many challenges, but I believe that many physicians and most patients still strive to find the optimal balance of humanistic qualities and scientific expertise.
Voltaire described physicians as a group who are “occupied in the restoration of health to other men, by joint exertion of skill and humanity. . .” However, the modern medical climate has altered this perception for a good number of folks. . .on both sides of the medical fence. The economic realities of our present health care system demand efforts at streamlining, cost-containment, surveillance of expensive diagnostic studies and hospital stays, and creation of formularies to manage costs of prescription drugs. Insurers are scrutinizing the efficiency of physicians’ practices, and all doctors have national computerized ‘profiles’ that monitor our practice and prescribing habits. In such an environment, it is easy for both patients and physicians to sense a loss of humanity in the whole process.
Sometimes, it seems that medicine has evolved into more of a business than a caring profession that uses science. Though there are days when I, as a physician, feel that pressures of paperwork and regulations dominate, an element of joy persists in my role as counselor and medical consultant to my patients. It’s still the communication and caring that balance the science and economics of medicine. And, I sustain my own enthusiasm by blending my scientific skills with the concepts and lessons of the humanities. After all, at the very root of each physician-patient encounter are shared fundamental human values.
“Disease in man is never exactly the same as disease in an animal for in man the disease at once affects and is affected by what we call the emotional life. Thus, the physician who attempts to take care of a patient while he neglects this factor is as unscientific as the investigator who neglects to control all the conditions that may affect his experiment. The good physician knows his patients through and through and his knowledge is bought dearly. Time, sympathy, and understanding must be lavishly dispensed, but the reward is to be found in that personal touch which forms the greatest satisfaction in the practice of medicine. One of the essential qualities of the clinician is interest in humanity, for the secret of the care of the patient is in caring for the patient.” Francis Weld Peabody 1927 Not always an easy task in today’s medical climate. . .but it’s this philosophy that remains the essence of the art of medicine. And, it’s the impetus that rousts me out of bed each Monday morning for another week at the office. Be mindful, too, of your critical role in self-care as the American health care delivery system evolves. Each of us is central to our own health maintenance, and our physicians are our educated consultants and allies in this process.
Stephen L. Hines, M.D.