American Journal of Medicine, internal medicine, medicine, health, healthy lifestyles, cancer, heart disease, drugs

Restoring the Art of Medicine

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There was a time when physicians and laypersons frequently and comfortably referred to the “art of medicine,” but that was 45 years ago. Times have changed. Back then, as an eager and idealistic medical student, the expression puzzled me and discussions with my classmates and teachers about its deeper meaning left me unsatisfied. For the first 2 years of medical school, the concept of artful medicine remained a haunting mystery that simmered below the avalanche of medical facts and disease processes I had to learn.

During my introduction to clinical medicine, while thumbing through the crinkly rice-paper thin pages of my newly purchased textbook, Principles of Internal Medicine by Tinsley Harrison, I paused a long time over several lines in the introduction from his first edition.1 They resonated within me and became the framework for my intrigue and later understanding of how a physician becomes an artist. Dr. Harrison spoke of the physician’s simultaneous obligation and opportunity, the basic requirements and spiritual values needed to be a physician and, most importantly, the “unique service” and “enduring character” that becomes the physician’s destiny, of which he or she should expect nothing more and be satisfied with nothing less.

Graduation and the Oath of Hippocrates presented more cryptic yet inspiring words that spoke to the ethics and spiritual dimensions of being a physician. As a young doctor, I and my classmates swore to “guard my life and my art in purity and holiness.” I was more determined than ever to understand the true meanings hidden in these words. More quotes from other great humanitarian scientists such as Sir William Osler, Albert Schweitzer, Oliver Sacks, and even Albert Einstein filled the gaps within Dr. Harrison’s unforgettable depiction of medicine’s inherent mysteries. Years later, it finally occurred to me that the art of medicine was as much about me as it was about being a competent doctor. From that moment on, I was irretrievably locked on the road to self-discovery and the exploration of the human experience through the eyes of a physician.

For the next 45 years, each patient experience presented me the opportunity and obligation to blend my personality, my core values, and my sense of humor with what being a physician meant to me. I soon developed my own style of interacting with patients until it became my unique way of being the doctor I always imagined. With constant attention to details, consistently honing my communication skills, staying alert to the advances within my science, and allowing myself to be touched by the best and the worst of humanity, I developed my unique style of practice, the expression of my dedication, my compassion, and eventually, my art. Each patient encounter, each prescription, each physician order, and each patient narrative for me became a creation of sorts to which I applied my signature a hundred times a day.

As with any authentic artistic pursuit, there is struggle and doubt along the way. But adversity and frustration heighten the creative tension within those physicians who relentlessly pursue their art because the pursuit becomes the expression of their commitment, their sacrifice, and their love for patients. My career path has twisted around health maintenance organizations, medical homes, accountable care organizations, preauthorizations, claim denials, consumerism, governmental bureaucracy, and medical directors from various payors telling me how to practice my art. The commercialization of health care, with its metrics and algorithms, was preventing me and my fellow physicians from realizing our destiny. The canvas on which artful physicians painted the stories of their patients’ lives and created their signature care plans blurred as the treadmill under our feet spun faster and faster.

Sir William Osler, the Father of Modern Medicine, said, “The good physician treats the disease; the great physician treats the patient who has the disease.” Physicians who practice an artful brand of medicine are destined for that Oslerian transformation to healer, where they become no longer the dispenser of therapies but rather the embodiment of therapy. Medicine no longer becomes a living for great physicians but rather a way of living. Tinsley Harrison’s prediction of a physician’s destiny is the end-point of an art well mastered.

Doctors Norman Shealy and Dawson Church, in their book, Soul Medicine,2 describe healers as physicians who “typically have strong spiritual practices and belief systems and who regularly induce feelings of peace and tranquility within themselves.” Physicians who have perfected their art have a spiritual practice focused on love and gratitude. Patients believe in them, trust them, and their mere presence induces healing.

Unfortunately, making the quantum leap to that higher echelon of medicine seems impossible in today’s health care environment. The landscape in which medicine is practiced today presents a moral hazard for most practitioners. Sadly, most of them and their teachers are totally oblivious to this situation. The corporatization of medicine dictates the delivery of health care; an individual’s expression of their art and hence, the transformative path to becoming the physician-artist and healer is blocked. The rules are set in the boardrooms, the paycheck guaranteed and the creative tension at the bedside vanquished. The result is a joyless practice of medicine, devoid of medicine’s artistry and burgeoning with frustrated physicians chasing Dr Harrison’s dream and unable to fulfill their oath. The current rise of physician burnout across all segments of medicine is the shocking proof. Doctors who want shift work, who see the relationship with their patients as an arm’s-length transaction, who value their private time more than their patient’s comfort, will thrive in today’s world of medicine, but those doctors, when judged through the eyes of the great medical icons, have settled for less.

After almost 45 years of medical practice “in the trenches,” I retired this year. But my art continues. I removed my primary care hat, closed my computer, erased my name from the on-call list, and gave up billing insurance companies. For me, the artist’s path to more perfect healing continues, but with a new expanse that includes equal attention to all aspects of the human experience—the body, the mind, and the human spirit. We physicians have always dealt with these 3 aspects from the first day of our internship—but not equally well. Corporate medicine no longer offered me the opportunity or obligation to appropriately deal with my patients’ emotions or their spiritual values. So, in 2008 I changed the direction of my path. It was a 2-year process—a fellowship that allowed me to integrate traditional clinical medicine with the evidence-based healing therapies from around the world that honored the whole person, their families of origin, their communities, and the spiritual context of their lives. I am now an advocate a counselor, a consultant, and a guide for patients who privately request me to be part of their medical team and to add my art to their plan of care.

Adding fellowship training in integrative medicine is only one of several ways physicians can restore their artful brand of medicine and transform. Those among us who yearn to be a healing presence for patients and long for the joy of medicine will seize the opportunity and step off the treadmill. Unless physicians take the opportunity to alter the character of their medical practice, this transformation from shift worker to physician–healer will never occur, and the caring, healing touch of the physician’s hand will continue to disappear. Physicians who see themselves as artists will forge their own destinies and settle for nothing less.

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-Joseph Mambu, MD

This article originally appeared in the December 2017 issue of The American Journal of Medicine.

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