VOLUME XVII - NUMBER 1
FIRST QUARTER, 1976
PSYCHOSOMATICS OFFICIAL JOURNAL OF THE ACADEMY OF PSYCHOSOMATIC MEDICINE
Where Have They Gone? THOMAS
C.
I pose a number of questions this morning, beginning with, "Where have they gone-those physicians who really cared about their patients and showed that they cared?" Perhaps you can come up with some answers. T.V.'s favorite M.D., Marcus Welby, portrays an understanding concerned humanitarian, determined to share himself and his talents with the patient. The public relates to this image and wonders, increasingly, where they can find a Dr. Welby in their home town. Are the Dr. Welbys merely fictional characters in living color . . .video projections of by-gone times? Is personalized patient care facing extinction, because in fact, the personal physician is fast on the road to becoming a vanishing breed? By what name do we call the thief who has crept into our domain, intent upon robbing and dulling our intuitive senses? There was a time in every physician's practice-building days, when he or she knew instinctively how to cope with a patient's needs and anxieties. Is the culprit simply the passage of time ... an unduly heavy schedule . . . a waning personal satisfaction, or perhaps a feeling of incompetency? However varied or universal the causes for this downtrend in personalized patient care-it is the individual physician, and he or she, alone, who must examine and arrive at a workable solution. Our patients come to us looking for solace and relief-for answers. After leaving their doctor's office, they are often more confused, discouraged and at times, irate, than when they entered. If the physician allows himself to continue thinking of the patient as a unit of time, rather than a fellow human being, he may well be his own undoing. Occasional patronizing attitudes must be exchanged for consistent sincerity in dealing with our patients and their needs. The physical complaints of at least 10% of all paRead as the Presidential Address at the 22nd Annual Meeting of the Academy of Psychosomatic Medicine, November 17, 1975, New Orleans, La. Jan.lFeb.lMarch. 1976
KALKHOF,
M.D.
tients stem from or are accompanied by mild or serious emotional problems. In no area of the humanities, and especially in medicine, can the nature of man be punctuated or sifted from the totality of his being. The famous painting, "The Doctor" depicts the physician sitting at a child's sickbed-lines and shades of concern evident in every part of his body. Though his scientific knowledge and resources were limited, this "Doctor of Yesteryear" inspired, even commanded, respect and reverence. While we have witnessed giant-like strides in medical therapy and technology, we have somehow lost sight of the basic ingredient of our profession-the concern of the physician for his patient-the confidence of the patient in his physician. If ours is becoming a somewhat battered image, can we innocently claim bewilderment or ignorance? The physician sets up, and, often, necessarily so, stringent standards for the patient. He often neglects, however, to structure or discipline his own time. With good planning and practice, the physician will find that he can meet both his own needs and those of the patient. If a patient requires more time than a physician can allow during a given visit, the patient should be so informed, and be asked to return at another day or hour. A physician-patient contract can be made which will satisfy the patient's need to spend more time with the physician. The malpractice web was not woven overnight. It has been spinning steadily, as medicine, over the years, has leaned more intently toward computerization and away from humanization. Hundreds of patient dollars are spent, annually, in the supermarket laboratories of ultra modern health centers. The supposition being that this is "the cool"-the safe and easy way to satisfy the patient. Automation, routine dependence upon paramedical personnel and quick clinical procedures are essential, at times, and have greatly aided the busy practitioner; but they are poor substitutes for a one-on-one, physician-patient relationship. 7
PSYCHOSOMATICS
Historically, the healer has relied upon his senses and a compassion for the suffering of others, to determine the patient's needs and treatment. The physicians touch, like the soothing touch of a mother's hands, tells the patient that his doctor cares about him and is rooting for his recovery and well being. Nowadays, physicians seem to be out of touch with touching. It is as though a veil has dropped, which if lifted, would pronounce a violation; a breaking of a sacred code of laws. Who or what is responsible for this barrier between physician and patient? More importantly, how can it be eradicated? Our profession has put a great deal of effort into educating patients . . . setting the terms . . . and letting patients know what is expected of them. Is it not time that the physician, too, embark upon re-educating himself to the realities of his profession? Surely, medicine will not permit itself to become but another segment of a growing Barbie-Doll Society. Plastic medicine is for plastic people. Real people need real, honest-toGod, involved physicians. Physicians who will reflect, with integrity, upon both their role and the role of the patient, before subscribing to wholesale diagnostics . . . physicians who are willing to switch rather than perpetuate the dehumanization of an honored profession. As we in the Academy know, all discomfort and pain are not conclusive evidence that a physical disorder exists. Such a disorder may be accompanied or aggravated by an emotional disorder. Many physicians may not realize how dependent they have become upon mechanical diagnoses. Psychosomatic illness is not as easily discernible as physical illness. In order to differentiate them, the physician may find it necessary to retrain himself in the use of his maximum diagnostic ability. Worthy of note and tribute is the physician of the past, Old Doc, who with little or no clinical assistance was able to make diagnoses with reasonable accuracy. Like a good detective, he listened carefully, examined thoroughly and exhausted every means at his disposal to learn all he could about his patient-even to making inquiries of the patient's family or friends. Like a good physician, he met and communicated with the patient on the patient's level. Developing detailed information is still an important part of our daily practice. Every physician can recall cases which, in spite of extensive clinical testing, necessitated further probing and sleuthing on his or her part, to reach a solution. I remember, with gratitude, a professor who constantly hammered away at the importance of treating the whole patient-not just the symptoms. This was not a really deep message, but a hell of a good one. For, truly, is there any other way to care for a patient? 8
Our need for advanced scientific knowledge and improved diagnostic tools, for the discernment and treatment of certain problems will never diminish, nor will the need for physicians who are prepared to care for the total patient. Most medicine in the past, and even today, could be termed "Crisis Medicine." It is the most costly type, for it requires a more alert, intensive and dramatic approach to a problem; and it does not meet the total needs of the patient. Immediacy is the name of the game and it is subject to a wide margin of error. It is important for the physician to be knowledgeable about a patient before the acute crisis occurs-for the crisis may critically change or affect the patient's normal or characteristic risk factors. Psychosomatic Medicine's sibling, Prospective Medicine, joined the Comprehensive Care Family to fill the need for recognizing certain characteristics associated with the development of disease.
Patient Data serves to identify individuals who have a higher than average risk factor. This is summarized in a 10-year health hazard appraisal which allows the physician to establish lines of defense early in the natural history of the disease; particularly in the areas of our five major killers: Coronary Disease, Motor Vehicle Accidents, Suicide, Cirrhosis of the Liver and Strokes. Our colleagues in Prospective Medicine build upon Medicine's strengths to determine and provide preventive care, thereby, lessening the need for crisis medicine. They have done a fine job in developing this system of risk recognigtion, but admit to experiencing problems in the selling of their preventive ideas. The key to prevention lies in the change of human behavioral patterns. It is in this area that members of the Academy of Psychosomatic Medicine may lend a hand. If we can find ways, for example, to alter patient habits, such as excessive smoking and drinking or poor nutrition, we could be instrumental in lowering the risk factors prominent in the five major causes of premature death. Earlier, this year, I had an opportunity to observe, in operation, the new CAIT machine (Computerized Axial Transverse Tomography). There were, at that time, only 100 such machines available for diagnostic medicine. The machine offers a horizontal non-invasive identification of the size, shape, location and density of intracranial lesions. The chief of the Neurological Department had only praise for this marvelous new diagnostic instrument, yet, confided that his expert interpretations were more definitive, helpful and accurate when he had access to a complete patient history and physical records. A lack of adequate history and physical information Volume XVII
WHERE HAVE THEY GONE?-KALKHOF
limits the expert's interpretation of any diagnostic test and also hinders his ability to shed as much light as possible on the matter at hand. The physician who relies on clinical studies alone is more technician than doctor. Every physician needs to return to the basics of Comprehensive Health Care-back to a one-on-one relationship with a patient. The concept that a physician, in the fullest sense, must practice the art of med-
icine, as well as the science of medicine, still holds true. As the Academy opens it 22nd Annual Meeting here in New Orleans, we look to each member to support and carry forward the Academy's main goal: Lighting a fire under the interest centers of non-members, with an invitation to share in the ideals and beliefs of Psychosomatic Medicine. 3815 Field St., Erie, Pa. 16511.
Call for Papers 1976 Annual Meeting Charleston, S. C. Nov. 6-9, 1976 The theme of the 1976 annual meeting is "Family Medicine in the Cycle of Life." Those wishing to present papers should send abstracts in triplicate to Program Chairman Barney M. Olin, M.D. 230 West AlIens Lane, Philadelphia, Pa. 19119. Of particular interest will be papers on the following subjects: Death and Dying, The Aged, Adolescence, Pediatrics and Pregnancy. Papers on other subjects will, of course, be welcome. The deadline for the submission of abstracts is April 15, 1976.
Jan.lFeb.lMarch. 1976
9
FIRST QUARTER, 1976
PSYCHOSOMATICS OFFICIAL JOURNAL OF THE ACADEMY OF PSYCHOSOMATIC MEDICINE
Where Have They Gone? THOMAS
C.
I pose a number of questions this morning, beginning with, "Where have they gone-those physicians who really cared about their patients and showed that they cared?" Perhaps you can come up with some answers. T.V.'s favorite M.D., Marcus Welby, portrays an understanding concerned humanitarian, determined to share himself and his talents with the patient. The public relates to this image and wonders, increasingly, where they can find a Dr. Welby in their home town. Are the Dr. Welbys merely fictional characters in living color . . .video projections of by-gone times? Is personalized patient care facing extinction, because in fact, the personal physician is fast on the road to becoming a vanishing breed? By what name do we call the thief who has crept into our domain, intent upon robbing and dulling our intuitive senses? There was a time in every physician's practice-building days, when he or she knew instinctively how to cope with a patient's needs and anxieties. Is the culprit simply the passage of time ... an unduly heavy schedule . . . a waning personal satisfaction, or perhaps a feeling of incompetency? However varied or universal the causes for this downtrend in personalized patient care-it is the individual physician, and he or she, alone, who must examine and arrive at a workable solution. Our patients come to us looking for solace and relief-for answers. After leaving their doctor's office, they are often more confused, discouraged and at times, irate, than when they entered. If the physician allows himself to continue thinking of the patient as a unit of time, rather than a fellow human being, he may well be his own undoing. Occasional patronizing attitudes must be exchanged for consistent sincerity in dealing with our patients and their needs. The physical complaints of at least 10% of all paRead as the Presidential Address at the 22nd Annual Meeting of the Academy of Psychosomatic Medicine, November 17, 1975, New Orleans, La. Jan.lFeb.lMarch. 1976
KALKHOF,
M.D.
tients stem from or are accompanied by mild or serious emotional problems. In no area of the humanities, and especially in medicine, can the nature of man be punctuated or sifted from the totality of his being. The famous painting, "The Doctor" depicts the physician sitting at a child's sickbed-lines and shades of concern evident in every part of his body. Though his scientific knowledge and resources were limited, this "Doctor of Yesteryear" inspired, even commanded, respect and reverence. While we have witnessed giant-like strides in medical therapy and technology, we have somehow lost sight of the basic ingredient of our profession-the concern of the physician for his patient-the confidence of the patient in his physician. If ours is becoming a somewhat battered image, can we innocently claim bewilderment or ignorance? The physician sets up, and, often, necessarily so, stringent standards for the patient. He often neglects, however, to structure or discipline his own time. With good planning and practice, the physician will find that he can meet both his own needs and those of the patient. If a patient requires more time than a physician can allow during a given visit, the patient should be so informed, and be asked to return at another day or hour. A physician-patient contract can be made which will satisfy the patient's need to spend more time with the physician. The malpractice web was not woven overnight. It has been spinning steadily, as medicine, over the years, has leaned more intently toward computerization and away from humanization. Hundreds of patient dollars are spent, annually, in the supermarket laboratories of ultra modern health centers. The supposition being that this is "the cool"-the safe and easy way to satisfy the patient. Automation, routine dependence upon paramedical personnel and quick clinical procedures are essential, at times, and have greatly aided the busy practitioner; but they are poor substitutes for a one-on-one, physician-patient relationship. 7
PSYCHOSOMATICS
Historically, the healer has relied upon his senses and a compassion for the suffering of others, to determine the patient's needs and treatment. The physicians touch, like the soothing touch of a mother's hands, tells the patient that his doctor cares about him and is rooting for his recovery and well being. Nowadays, physicians seem to be out of touch with touching. It is as though a veil has dropped, which if lifted, would pronounce a violation; a breaking of a sacred code of laws. Who or what is responsible for this barrier between physician and patient? More importantly, how can it be eradicated? Our profession has put a great deal of effort into educating patients . . . setting the terms . . . and letting patients know what is expected of them. Is it not time that the physician, too, embark upon re-educating himself to the realities of his profession? Surely, medicine will not permit itself to become but another segment of a growing Barbie-Doll Society. Plastic medicine is for plastic people. Real people need real, honest-toGod, involved physicians. Physicians who will reflect, with integrity, upon both their role and the role of the patient, before subscribing to wholesale diagnostics . . . physicians who are willing to switch rather than perpetuate the dehumanization of an honored profession. As we in the Academy know, all discomfort and pain are not conclusive evidence that a physical disorder exists. Such a disorder may be accompanied or aggravated by an emotional disorder. Many physicians may not realize how dependent they have become upon mechanical diagnoses. Psychosomatic illness is not as easily discernible as physical illness. In order to differentiate them, the physician may find it necessary to retrain himself in the use of his maximum diagnostic ability. Worthy of note and tribute is the physician of the past, Old Doc, who with little or no clinical assistance was able to make diagnoses with reasonable accuracy. Like a good detective, he listened carefully, examined thoroughly and exhausted every means at his disposal to learn all he could about his patient-even to making inquiries of the patient's family or friends. Like a good physician, he met and communicated with the patient on the patient's level. Developing detailed information is still an important part of our daily practice. Every physician can recall cases which, in spite of extensive clinical testing, necessitated further probing and sleuthing on his or her part, to reach a solution. I remember, with gratitude, a professor who constantly hammered away at the importance of treating the whole patient-not just the symptoms. This was not a really deep message, but a hell of a good one. For, truly, is there any other way to care for a patient? 8
Our need for advanced scientific knowledge and improved diagnostic tools, for the discernment and treatment of certain problems will never diminish, nor will the need for physicians who are prepared to care for the total patient. Most medicine in the past, and even today, could be termed "Crisis Medicine." It is the most costly type, for it requires a more alert, intensive and dramatic approach to a problem; and it does not meet the total needs of the patient. Immediacy is the name of the game and it is subject to a wide margin of error. It is important for the physician to be knowledgeable about a patient before the acute crisis occurs-for the crisis may critically change or affect the patient's normal or characteristic risk factors. Psychosomatic Medicine's sibling, Prospective Medicine, joined the Comprehensive Care Family to fill the need for recognizing certain characteristics associated with the development of disease.
Patient Data serves to identify individuals who have a higher than average risk factor. This is summarized in a 10-year health hazard appraisal which allows the physician to establish lines of defense early in the natural history of the disease; particularly in the areas of our five major killers: Coronary Disease, Motor Vehicle Accidents, Suicide, Cirrhosis of the Liver and Strokes. Our colleagues in Prospective Medicine build upon Medicine's strengths to determine and provide preventive care, thereby, lessening the need for crisis medicine. They have done a fine job in developing this system of risk recognigtion, but admit to experiencing problems in the selling of their preventive ideas. The key to prevention lies in the change of human behavioral patterns. It is in this area that members of the Academy of Psychosomatic Medicine may lend a hand. If we can find ways, for example, to alter patient habits, such as excessive smoking and drinking or poor nutrition, we could be instrumental in lowering the risk factors prominent in the five major causes of premature death. Earlier, this year, I had an opportunity to observe, in operation, the new CAIT machine (Computerized Axial Transverse Tomography). There were, at that time, only 100 such machines available for diagnostic medicine. The machine offers a horizontal non-invasive identification of the size, shape, location and density of intracranial lesions. The chief of the Neurological Department had only praise for this marvelous new diagnostic instrument, yet, confided that his expert interpretations were more definitive, helpful and accurate when he had access to a complete patient history and physical records. A lack of adequate history and physical information Volume XVII
WHERE HAVE THEY GONE?-KALKHOF
limits the expert's interpretation of any diagnostic test and also hinders his ability to shed as much light as possible on the matter at hand. The physician who relies on clinical studies alone is more technician than doctor. Every physician needs to return to the basics of Comprehensive Health Care-back to a one-on-one relationship with a patient. The concept that a physician, in the fullest sense, must practice the art of med-
icine, as well as the science of medicine, still holds true. As the Academy opens it 22nd Annual Meeting here in New Orleans, we look to each member to support and carry forward the Academy's main goal: Lighting a fire under the interest centers of non-members, with an invitation to share in the ideals and beliefs of Psychosomatic Medicine. 3815 Field St., Erie, Pa. 16511.
Call for Papers 1976 Annual Meeting Charleston, S. C. Nov. 6-9, 1976 The theme of the 1976 annual meeting is "Family Medicine in the Cycle of Life." Those wishing to present papers should send abstracts in triplicate to Program Chairman Barney M. Olin, M.D. 230 West AlIens Lane, Philadelphia, Pa. 19119. Of particular interest will be papers on the following subjects: Death and Dying, The Aged, Adolescence, Pediatrics and Pregnancy. Papers on other subjects will, of course, be welcome. The deadline for the submission of abstracts is April 15, 1976.
Jan.lFeb.lMarch. 1976
9
![[Hippocrates, have they gone mad?].](/assets/img/hold.png)
