Practicing medicine is rather simple when you break it down
into the relevant tasks a physician is expected to perform. There is taking a
complete history of the patient’s current complaints, past medical history,
social history including alcohol and drugs, past surgical history, pertinent
family history, allergies and current medications. After taking a thorough
history, one will usually then conduct a Review of Systems asking
straightforward questions for all the body systems in order to elucidate
possible issues that the patient may have “forgotten about” due to the pressing
nature of the chief complaint. This is then often followed by an assessment of
vital signs and finally by the ritualistic physical exam. While this may be the
end of the formal patient and doctor encounter, it is by no means the end of a physician’s
responsibilities. Following this interaction, a doctor may begin documentation
into an electronic health record- if not conducted during the interaction
itself, verbal documentation of one’s decision making as part of the “work-up”
for the patient’s present complaints, a plan for further diagnostic imaging and
laboratory studies to help narrow the list of possible diagnoses, and lastly
the development of a final assessment and plan for treatment. When conducted in
the academic hospital setting, a formal presentation to other team members regarding
the course of therapy is often conducted as well. Following all of these formal
processes, the doctor can then return to discuss and initiate a treatment plan
with the patient, provide education for self-guided therapy and prescribe drugs
or additional medicines. There it is, a doctor’s duties in a paragraph, and yet
the process of obtaining the skills to complete all of these tasks effectively
takes an entire lifetime. And as I will argue, if one simply follows the
template above, I don’t think we will ever reach the ultimate goal of
practicing medicine: providing vitality and well-being to all patients who seek
our help.
While I have
spent the entirety of this post describing the current formal, medical
interaction, I have realized through my training that despite that fact that
this framework has provided a reasonable means for treating disease within the
Western Medicine system, and the reality
that this type of interaction has been performed for years with relative success,
doesn’t mean we can’t improve or even more shockingly, that this method may
simply be inadequate for relieving most suffering. While at this point in my
training as a third year medical student, I by no means can provide the array
of care conducted at the hospital by nurses, residents, attendings, or other
staff, but what if we changed the rules of the game and redefined what it meant
to treat illness. While my years of practicing medicine upon completion of my
training are still years off, I feel obligated to share a different method for
approaching the patient encounter to all those currently healing the sick, for
as I see it, you cannot change a system, you can only provide a different
perspective that allows those around you to choose for themselves what is worth
the time and effort. Nothing is more precious than an individual’s time so why
not use your 15-minute encounter for something meaningful, even if it means
disregarding the ROS, eliminating electronic documentation or completely
ignoring medication reconciliation.
So in a four-part blog series to follow, I will provide a
potential substitute for the History, ROS, Physical Exam, and Treatment. For
the sake of humor I will call it the Abbott
Way: A Life Story, A Nourishing Review, A Healing Touch and A Goal-Directed
Acton Plan. While each of these practices can be implemented separately as part
of a physician-patient interaction, I whole-heartedly believe and plan to
utilize all 4 as part of my normal encounters with people everyday. To be
honest, I think I would be doing a disservice if my medical care did not involve
all four of these practices. After finishing the series, I hope that you may
share this same view.
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