Commentary

A Clinician's View: The Art of Medicine

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I walked into the examination room to find a 7-year-old boy presenting with mild to moderate abdominal pain. His name was Chase. After hearing the symptoms his mother had observed and conducting a physical examination, I determined that he most likely had appendicitis. I sent him directly to a children’s hospital, where a CT scan was performed, confirming my diagnosis. He was in surgery by early afternoon. The surgeon found that the appendix was near perforation but had not yet ruptured.

The interesting twist to this case is that Chase’s mother initially was not going to schedule an appointment with me because I was a PA and not an MD. She had always seen a physician before and didn’t understand exactly what a PA did. After Chase recovered from surgery, he told his mother that he wanted to see me again so that he could thank me, and at a follow-up visit, he gave me a big hug. That was when his mother told me that she’d had reservations about seeing me. The only reason she changed her mind was because Chase was in pain and I had an opening before lunch.

“But from now on,” she said, “you’re the only one I want to see.”

She was grateful, of course, that I had been able to diagnose her son’s condition before it became a full-fledged emergency. But there was more to it than that.

“I appreciated the way you took the time to explain things, to listen, and to speak directly to my son with genuine care and concern,” she said.

You can learn a great deal about yourself and your skill as a clinician from listening to your patients and their perception of you. In medicine, especially in pediatrics, it is important to address the patient directly. I have found that it actually empowers children when you do this. The additional information that you can get from a child or adolescent patient when you allow him to speak for himself can be extremely helpful. Often, it is information that the parent didn’t even know. The extra time that it takes to build these relationships is well worth it.

Another benefit to actively involving pediatric patients in their own health care is that when they grow up they may be more likely to have routine physicals and to take better care of themselves. Explaining to children why you are giving them a particular medication, that it’s what they need to make them feel better, can have a much more positive impact than just having their mom or dad stop by a pharmacy and fill a prescription. It is especially empowering when you involve them in the process by asking them a question such as “Would you like a pill or a liquid medication?” You know they’ll choose the liquid, but giving them a choice like that can make a huge difference.

This particular case I’ve shared with you here has also taught me how important it is to listen to our patients when they compliment and when they criticize us. We can gain insight from them on how we are projecting ourselves as clinicians and as a profession. It is important that we remember the influence we have each day when we walk through that exam room door. Patients—again, especially children—pick up on your demeanor immediately. So I encourage you to walk into work each day excited about what you do and eager not only to diagnose and treat but also to listen and learn.

No matter what field you’re in, whether academic or clinical, your influence is not short-lived. Rather, you are molding lives every day. The time we give to listen to and take an interest in our patients contributes greatly to the making of a skillful clinician. As Sir William Osler said, “The practice of medicine is an art, based on science.”

Chad R. Stough practices at West Atlanta Pediatrics in Dallas, Georgia.

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