The Art Of Medicine By Kevin J Soden MD: A Personal Perspective

I am keenly interested in the Medical Humanities and the art of medicine. I am of the opinion that the 'art of medicine' has been squeezed by the science of medicine. We may be producing technically competent doctors, but at the cost of their innate humanness. I had conducted a voluntary medical humanities (MH) course for interested medical students and faculty members at the Manipal College of Medical Sciences, Pokhara, Nepal. At present, I am conducting an MH module for faculty members and medical and dental officers at the KIST Medical College, Lalitpur. With this background, I really enjoyed reading the book by Dr. Soden.

The author has hit upon a very innovative way to make the book interesting and gripping for the readers. He has created a character that he calls 'the student', whom he guides through various experiences during medical school. The first chapter starts with 'the student' getting injured in a basketball game and visiting the emergency room (ER) for treatment. The patients in the ER were commenting on the rather blunt way in which doctors deal with patients these days, and the lack of common courtesy and kindness in the relationship. An important statement is that 'History taking alone accounted for the correct diagnosis almost 70% of the time'. History taking is a vital part of the exam, and should be stressed more in medical school.

The chapter 'Beginning the art of medicine and finding your dream' introduces 'the student' to his advisor who would serve as his mentor for learning the art of medicine. The student plans to be an interventional radiologist, and was of the opinion that the art of medicine was a waste of his time and was too touchy-feely. The layout of the advisor's room is different, and serves to reduce the barriers to the doctor-patient or mentor-mentee communication. The role of managed care organizations (MCOs) and their effect on the doctor-patient relationship is a recurring theme throughout the book. The internet has also had a tremendous effect on the doctor-patient communication. Medical students and doctors are much respected by society, and have a lot of responsibilities thrust up on them at an age when they are still emotionally immature. In our part of the world, students can enter clinics by the time they are eighteen or nineteen, and at this relatively young age, they carry a lot of expectations on their shoulders.

The second chapter is mainly about communicating. We have been using standardized patients for communication skills training at the Manipal College of Medical Sciences, Pokhara, Nepal, and plan to do the same at KIST Medical College. Standardized patients offer a number of advantages and a number of challenges. In our part, the teaching takes place in English, thus excluding a number of standardized patients from decisions about and involvement in their treatment. The United States (US) is an egalitarian society, and it was interesting to learn about patients taking an active part in educating students. In an emergency room (ER), the encounter between a patient and a health care provider may be a one time affair, and may never be repeated, while in the case of the family physician, repeated encounters lead to a very close and personal relationship, and the doctor may be regarded almost as a member of the family. Because of this close and personal relationship, even in a highly litigation prone society like the US, family physicians are sued significantly less often, compared to other specialties.

Listening is the key to healing, and the doctor may cure sometimes, but should comfort always. This is the theme of the third chapter. The various barriers to 'effective listening' have been neatly covered by the author. ‘The mind can take in only what the ass can endure’, is a true aphorism. Bad seating in lecture halls, out patient departments (OPDs) and seminar rooms can be a barrier to effective listening. Body language and facial expressions are regarded<