PRESIDENTIAL ADDRESS
The Whole Patient Is Not Less Than the Sum of His Parts JOSEPH D. SAPIRA, MD
an exclusive approach to patients. I believe these are also related to the failure ".. .Our age takes a more skeptical role of of our Society to exert as much influence the individual than did the eighteenth on the practice of medicine as past speakand the first half of the nineteenth cen- ers from this podium would have pretury. For the extensive specialization of ferred. For instance, recently, after 2 the professions and of knowledge lets the weeks of failure in getting my car to run individual appear "replaceable" (au- (every conceivable part having been reswechseJbar, closer to interchangeable) placed), the mechanic turned to me in like a part of a mass-produced machine." frustration and said in all seriousness, "Well, Doc, I know it's not organic." Albert Einstein What do I mean by reductionism? Rein the Foreword to Galileo's Dialogue Concerning the Two Chief ductionism is the philosophy that biologic World Systems (1) events can be understood by reducing them to their component parts proceeding As best I can determine, Maximus of down levels of organization of increasTyrrhus was the first philosopher to decry ingly smaller scale. For instance, to unboth subspecialization and the tendency derstand the disease of a whole patient, of doctors to divide the mind from the we examine the separate organs of the body (2). That was about 2000 years ago. patient, visualizing them radiologically or I believe the phenomena of mind-body at surgery or at autopsy. If we still cannot dichotomization and over subspecializa- figure out what happened, we reduce our tion are related through the philosophy of level of investigation below the organ reductionism when the latter is used as level and use the light microscope for examining the cellular level. This may permit us to see things that could not be seen at the higher level of organization. Presented at the Annual Meeting of the American Sometimes even the light microscope does Psychosomatic Society, New York, New York, not suffice and we must go to the level of March 1992. the electron microscope. Sometimes we From the Department of Medicine, Saint Louis go down to the molecular level as when University, and the St. Louis VA Medical Center. Received for publication lanuary 15, 1992; revi- we ask, "What was the patient's blood sugar this morning?" Sometimes we even sion received March 27. 1992 INTRODUCTION
Psychosomatic Medicine 54:383-393 (1992) 0033-3174/92/54O4-O383$03.O0/O Copyright
The Whole Patient Is Not Less Than the Sum of His Parts JOSEPH D. SAPIRA, MD
an exclusive approach to patients. I believe these are also related to the failure ".. .Our age takes a more skeptical role of of our Society to exert as much influence the individual than did the eighteenth on the practice of medicine as past speakand the first half of the nineteenth cen- ers from this podium would have pretury. For the extensive specialization of ferred. For instance, recently, after 2 the professions and of knowledge lets the weeks of failure in getting my car to run individual appear "replaceable" (au- (every conceivable part having been reswechseJbar, closer to interchangeable) placed), the mechanic turned to me in like a part of a mass-produced machine." frustration and said in all seriousness, "Well, Doc, I know it's not organic." Albert Einstein What do I mean by reductionism? Rein the Foreword to Galileo's Dialogue Concerning the Two Chief ductionism is the philosophy that biologic World Systems (1) events can be understood by reducing them to their component parts proceeding As best I can determine, Maximus of down levels of organization of increasTyrrhus was the first philosopher to decry ingly smaller scale. For instance, to unboth subspecialization and the tendency derstand the disease of a whole patient, of doctors to divide the mind from the we examine the separate organs of the body (2). That was about 2000 years ago. patient, visualizing them radiologically or I believe the phenomena of mind-body at surgery or at autopsy. If we still cannot dichotomization and over subspecializa- figure out what happened, we reduce our tion are related through the philosophy of level of investigation below the organ reductionism when the latter is used as level and use the light microscope for examining the cellular level. This may permit us to see things that could not be seen at the higher level of organization. Presented at the Annual Meeting of the American Sometimes even the light microscope does Psychosomatic Society, New York, New York, not suffice and we must go to the level of March 1992. the electron microscope. Sometimes we From the Department of Medicine, Saint Louis go down to the molecular level as when University, and the St. Louis VA Medical Center. Received for publication lanuary 15, 1992; revi- we ask, "What was the patient's blood sugar this morning?" Sometimes we even sion received March 27. 1992 INTRODUCTION
Psychosomatic Medicine 54:383-393 (1992) 0033-3174/92/54O4-O383$03.O0/O Copyright
