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OB/GYN Editorial July 2002
Medical Practice: Using the Right Model
Terence W. Starz, MD
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Sir William Osler, one of the fathers of modern medical practice,
said in 1892: "The practice of medicine is an art, based on science."
How do today's practicing physicians determine what should be done
in the evaluation and treatment of their patients? Is Osler's model
still applicable in 21st-century medicine? Certainly science forms
the fundamental basis of how physicians deliver care. The art of medical
practice has historically been conveyed by an apprenticeship training.
Physicians can vividly recall physician-teachers whose practice styles
and decision-making processes continue to influence their own practice
patterns. In addition, physicians' own experiences have a tremendous
influence on how they practice and make decisions. Osler reminds us,
however, that "we the doctors are so fallible, ever beset with
the common and fatal facilities of reaching conclusions from superficial
observations, and constantly mislead by the ease with which our minds
fall into the ruts of one or two experiences."
Medical care today is challenged by a number of complex and constantly
changing factors including dramatically advancing technology,
ever
higher expectations of both patients and physicians, and the limited
capacity for our society to support the over $1 trillion in health
care cost expenditures per year in the USA. Furthermore, there
are complex new ethical and legal considerations. These factors
have
strained the dynamics of the relationship between physicans and
patients. Physicians are no longer as free as they once were to
practice, now constrained by these issues and their capacity to
assimilate all of the new information. What is the basis on which
health care professionals should make their decisions? Let us not
forget the wisdom of Sir William Osler. We physicians must focus
our attention on integrating the science with the art of medicine
and trying to eliminate the tensions between the two. The foundations
of medical practice must always begin with the consideration of
the well-being of the patient and our responsibility for navigating
their medical care. Osler said, "To wrest from nature the
secrets which have perplexed philosophers in all ages, to track
to their
sources the causes of disease, to correlate the vast stores of
knowledge, that they may be quickly available for the prevention
and cure of
disease these are our ambitions."
Terence W. Starz, MD
Advisory Board Member
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