The “Art” of Medicine is Making a Comeback

November 2011

If medicine is both an art and a science, it is Tom Hutchinson’s contention that the art was too often ignored in the 20th century. But in the 21st century, the art is making a comeback, and perhaps no medical school is better equipped to show the way than McGill. Whole Person Care: A New Paradigm for the 21st Century, edited by Hutchinson, brings together Balfour Mount, Richard and Sylvia Cruess, Abraham Fuks, BSc’68, MDCM’70, and numerous other experts to explore how the field of medicine is reviving the tradition of physician-as-healer and ensuring a transformation of today’s fast-paced and technologically advanced health care system. Whole Person Care will be launched November 18, 2011.

Dr. Nadine Arvisais does a check-up on patient, Mme Berard-Larose. Photo: Owen Egan.

 

“Patients are less and less happy with the medical profession because at a deep level they’re not getting what they need,” says Hutchinson. Currently Director of McGill Programs in Whole Person Care, as well as attending physician in the Division of Palliative Medicine at the McGill University Health Centre, Hutchinson’s career has followed the path that he felt would best address this apparent dissatisfaction among patients. Starting out as a nephrologist, he dramatically changed course in the 1980s after meeting Virginia Satir, the renowned family therapist. “[From her] I learned a lot about people and how they respond to difficult issues in their lives and how you can help them,” Hutchinson says. He made the switch to palliative medicine, working alongside Balfour Mount, and grew in his conviction that “the basis of medicine is not science; the basis of medicine is relating to other human beings and helping them through illness.”

As the Cruesses argue in their chapter, “the evolution of the practice of medicine, whose history is firmly rooted in the art of healing, is paradoxical.” It would appear that “whole person care” was something that physicians such as Hippocrates, and his forebears and successors, were doing well before the term was coined. But with the advent of the scientific era of medicine in the 19th century, and with the increasing specialization that occurred over the second half of the last century, whole person care appeared to decline. The paradox is that medicine can cure more ailments for more patients than ever before, yet trust in health care practitioners is declining and patients long for a return to a meaningful one-on-one relationship with a physician.

Whole Person Care argues for a new paradigm in which the empirical methods of science are entwined with the art of healing, which requires going beyond a focus on a body and its diseases to encompass the individual suffering with the disease. In his chapter, Eric Cassell makes a useful analogy to another profession: “Architects, for example, do not join two kinds of knowledge – aesthetics and engineering – at the end of their design. These … are an entwined part of their thinking all the time…”

Through chapters on “mindfulness” – an approach to medical practice that requires openness and perceptual clarity – as well as on the language of medicine, alternative therapies, the role of death anxiety, professionalism, genetics, and other topics, Whole Person Care serves as a guide for students, practitioners, teachers and the general public.

When asked if McGill is unique in its attention to whole person care (the current MDCM curriculum comes to mind), Hutchinson argues that it is, and that’s due, in part, to the Oslerian tradition, “which is extremely strong at McGill.” It is from Sir William Osler, after all, that Hutchinson borrowed the book’s introductory epigram: “The practice of medicine is an art, not a trade; a calling, not a business; a calling in which your heart will be exercised equally with your head.”

[Laurence Miall]

Whole Person Care is published by Springer and will be launched at the McGill Bookstore on November 18. Click here for more information. Tom Hutchinson’s introduction will be followed by comments from Balfour Mount and other distinguished guests. To attend, RSVP at thomas.hutchinson@mcgill.ca or 514-398-8679.

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Comments

11 Responses to “The “Art” of Medicine is Making a Comeback”
  1. Theresa Wang says:

    Finally! Medicine is an art! Not a practice of reciting the latest in knowledge or ordering a bunch of lab tests. Even when there is a lot of science involved such as in critical care there is the nuance of giving drugs, titrating drugs. It is the psychology of the person that effects the outcome but really the healing begins with the relationship between doctor and patient. Theresa Wang family medicine at Herzl clinic at Jewish General hospital, 16 years of experience, now a patient after an aneurysm and a motor vehicle accident (sustained head injuries and multiple fractures including neck fractures.

  2. I wish I could swallow the blithe affirmation that the art of medicine is returning, but every day, as a new dictum (from government, insurors, the ivory tower of academia itself) interferes with artful practice with new nonsense specifications. There is at least once every day where I find myself musing about the early history of man/woman when I did my training (you know—back when we trained in caves….), and it was still considered important to relate to patients as people, and, along with sussing out their maladies,and finding ways to treat them, it was incumbent upon docs to recognize and try to alleviate also some of the suffering, uncertainty, and fear that beset sick people.
    Except that now, they are no longer people. There are no longer any individuals in the patient population, for they are all described by the same dropdown words and phrases of the modern EMR. And no one dares to hang his hat on a diagnosis that wasn’t elevated to the level of Truth by $30,000 dollars’ worth of imaging and bloodwork. (“Well, I’ve seen this before. It looks like a pneumothorax. How can I be sure without some more testing? Well, when your granny walks through the door, how do you know it’s really her,and not someone else? Without doing a whole lot of imaging, I mean…”
    If the art of medecine really is making a comeback,someone’s going to have to prove it to me. Maybe with a whole lot of expensive imaging, and the achievement og 116 “bullets” in the final report…..?

  3. Carroll A. Laurin says:

    You might be interested in knowing that for the past 10 years the ‘Julie Prize” has been awarded to the orthopedic resident, on the McGill orthopedic training program, who has exibited “whole perso care”. He/She is selected by all members of the medical team (physicians ( attending staff and residents, nurses, orderlies, secretaries ,etc) who are canvassed by the program chairman and the prize is awarde annually during the visit of the ANNUAL VISITING PROFESSOR.
    FOR MORE INFORMATION CONTACT Mrs. FRANCINE LEMAY, the secretary of the McGill orthopedic training program.

  4. Dr. Nasir Khan MD, MS, FCPS says:

    Over the last few decades, the concept of a physician as healer has been tarnished by labelling it as “paternal approach”. The liability issues as professed in USA was icing on the cake. Physicians became more like computers. Fill in the data, find the possible outcome, list the differentials and order a plethora of investigations. When in doubt refer the patient to your colleagues, not to find the answers but to avoid liability issues. This whole saga lead to the loss of fundamental concept that is the role of a physician as a healer of body and mind. Patients righlty labelled it as technician approach. It is interesting to see that the old paternal approach is regaining its ground but I believe it will need a decade of work to get back to square one and then re-eshtabling the role of physicians as a whole body care-giver.

  5. Natalie Strychowsky, Occupational Therapist at the Douglas Mental Health University Institute for Mental Health says:

    As a health care professional and as a human being/ patient presently undergoing extensive investigation for my various ailments/symptoms that seem so difficult for the doctors to ”diagnose”, I am thrilled to see that there are individuals out there that are seriously devoted to making some long-needed changes in this area. I strongly believe that TRUE healing can only take place through a thorough assessment of ALL aspects of the individual (including mind, body, AND spirit), in order to hopefully determine what lies at the root of the ”problem”….because otherwise, even the best ”band aid solutions” (ex: drugs that treat symptoms only–and then other drugs to treat the side effects of those first set of drugs…, invasive surgeries that may not be necessary, etc…) cannot cure the suffering. The only way to accomplish the above (in my opinion) is for the medical practitioner to take the time necessary with his/her patient, to listen and to show some real empathy and understanding for the human being sitting in front of him/her who is suffering, and I can tell you from personal experience that this makes ALL the difference in the world…An immense thank you to Dr. Adam Gavsie, a McGill-trained medical doctor who takes the time to look at the WHOLE person and, in my opinion, truly understands the art of integrating traditional medicine with alternative/ complementary therapies, and to Orna Villazan, naturopathic doctor, who clearly understands the importance of looking at ALL aspects of the individual in her practice as well…and to all of the other individuals/medical practitioners that together, have also played a very significant role in helping me to find ” just one more piece” of the complex puzzle that each of us human beings really are.

    Although I may not have all of the pieces of the puzzle just yet, I am confident and hopeful that it will happen one day soon…but until then, I urge others like myself to speak out and let the medical community (and whomever crosses your path) know how important it is to embrace and practice this ”Whole Person Care” model (or as we say in OT, ”client-centered” approach to care.
    Speaking from experience, I can tell you that you will greatly appreciate and best understand the importance of this person-centered approach when YOU (or a loved one) become a patient yourself…

  6. Dr. Nasir Khan MD, MS, FCPS says:

    Over the last few decades, the concept of a physician as healer has been tarnished by labelling it as “paternal approach”. The liability issues as professed in USA was icing on the cake. Physicians became more like computers. Fill in the data, find the possible outcome, list the differentials and order a plethora of investigations. When in doubt refer the patient to your colleagues, not to find the answers but to avoid liability issues. This whole saga lead to the loss of fundamental concept that is the role of a physician as a healer of body and mind. Patients righlty labelled it as technician approach. It is interesting to see that the old paternal approach is regaining its ground but I believe it will need a decade of work to get back to square one and then re-establishing the role of physicians as a whole body care-giver.

  7. Michael Weinberger, MDCM '94 says:

    Well, in general, I tend to describe medicine as Magic…in the truest sense of magic of science elevated to an art, rather than mystical meaning of magic. I found that my training there at McGill really fostered that observation. Anyway, I have gone on to “specialize” as a General Internist AND a Pediatrician. I know that sounds like a joke to even suggest that combining to such general fields is even remotely a speciality. But I guess in the vein of this discussion, it is really a speciality IN the whole person. I had never thought of it that way before. I am by no means an expert in cardiology, or endocrinology, nor pediatric or adult pulmonology, etc. However i am thoroughly versed in all of those and basically any other speciality or subspeciality that I can and do interact with my patients as a mediator, filter, and teacher to help them understand everything bombarding them. We live in an age of such medical complexity and speciality by necessity that the specialists and ultra-specialists are necessary. I mean do you want the surgeon who is grafting you Mitral valve to even be a “c-t surgeon” OR the c-t surgeon who does 8-10 Mitral valves per week! I think the roll of the “whole person healer” in the modern age is even more important, to help the person to understand and believe in the decisions and treatments given to him or her, which is still important to the effectiveness of the management at hand. That takes broad in-depth training and strongly built rapport with patients, but is in no way in conflict with speciality care, and must not be seen as a “cost saving” measure to skirt speciality management whenever and wherever needed.

  8. Tom Hutchinson says:

    It is very encouraging to read the comments on the article related to our book on whole person care. I realize that healthcare workers at McGill have no problem understanding exactly what we are talking about even before they have read the book. I agree with all of the comments which for me summarize as follows: Currently, healing in medicine is sorely lacking and there is even a feeling that we are moving in the opposite direction despite some individual encouraging exceptions. What is needed is to combine our excellent ability to cure with an equal ability and emphasis on relating to the patient as a whole person, which is where healing arises. With the increasing complexity of medicine this is more needed than ever before. Some of you are more optimistic and some less so, and I sometimes waver myself, but overall I do believe it is possible to turn things around. McGill has already begun to take steps in that direction, particularly in how we are now beginning to educate medical students. But there is a long way to go and I hope that our book may play some role in this process. If you would like to participate further in these ongoing developments attending the launching of the book might be a next step. You would be most welcome. (Details above but it is at the McGill Bookstore on McTavish next Friday, November 18 from 2 to 4 pm).

  9. Brenda Markland says:

    The best art is that of listening. Patients want to feel that we have listened to both their symptoms and their concerns. Complaints often come from patients who feel they have been given short shrift. Unfortunately, the shortage of physicians means that there is a poor choice available to many doctors: try to see more patients to help more people, or see fewer patients in greater length while building up a longer waiting list. Catch 22.

  10. Hyman Zuckerman says:

    Note: I accidentally sent off a slightly earlier version that required editing. Please replace that with the following:

    I share the reservations of Dr. Selvaggi in his November 10 comment. Unfortunately, increasing materialism augers poorly for increased trust, or a return to the prized trust between doctor and patient of former times (or for trust between individuals in society widely). In 1972 there was medico-legal panel meeting in Windsor to discuss to discuss problems associated with attempts to define the exact time of death. In the Gazette’s (Montreal) report on the meeting Dr. Wilfred Bigelow is quoted as saying that in his thirty-two years as a cardiac surgeon had left him no doubts that there is a soul…. that having been at the side of many a patient at that moment and observed changes (such as loss of luster in the eyes), he saw them as evidence upholding the existence of the soul (though he admitted that it was difficult to document observations but he urged that research be done to determine what it is and where it comes from. J. Francis Leddy, president of the University of Windsor, another panel member, is quoted in the article as saying that “if there is a soul, you are not going to see it. You are not going to find it. If there is a principle of vitality or life, what is it? … the soul doesn’t exist anywhere specifically, geographically. It’s everywhere and yet it’s nowhere in the body” and that it would “be nice to start experimenting, but I don’t know how you are going to get on any of these things,” Maybe so, said Bigelow, but in modern medicine when something could not be explained, “the watchword is discover the answer, take it into the laboratory, take it somewhere where you can discover the truth.” The central question is “where is the soul and where does it come from?” At the very same time I found myself very much concerned with soul matters and on my way to India where I have remained more or less continually to date. Though largely hidden by superficial appearances of modernity from the perception of the average tourist or brief visitor to the country, an unbroken history of simplicity of way of life still affects a sizeable proportion of the population here and conduces to inquiries on soul matters. (I have some realizations on the subject that I am willing to share…. look me up on FaceBook). But one thing certain, talk of “whole person care” will remain simply talk unless doctors can first learn to identify their own personhood as distinct from the complex consisting of the body plus the set of conditional thoughts and behaviours the aggregate of which in the western, or materialistically advanced world, is misidentified as the person.

    H. Zuckerman M.D.C.M. ’68

  11. Rev. Radha-Govinda Swami says:

    I was referred here by one of the commenters. There is the person IN the body, the body basically being a machine, the person IN the body undergoing suffering due to various malfunctionings of the machine. How wonderful it would be if doctors will learn to relate to the patient, the person within the bodily machine, as opposed to simply being chemists and mechanics who relate only to the machine, and not the person, often enough, not listening to what the patient is telling them, and throwing this medication (that doesn’t do anything to help the patient, and even makes things worse due to the side effects caused by the medication. Certainly a doctor is not God, but if they would relate to the person who is explaining the suffering they are experiencing, and would take seriously what the patient is saying, as opposed to what the doctor decides to conjure up on their own speculations and ignore the patient’s input, I believe doctors would be much better able to help relieve more patients of at least some of their suffering. I will also add that it is MOST FRUSTRATING to go a doctors, tell them that something is a problem, and they will totally ignore (and deny) what the patient is telling them, TOTALLY INvalidating the patient, and what the patient has told them. I can’t even begin to count how many times this has happened with me in regards to my body being fat, but my eating practically nothing (because of digestive problems as well as my having practically no appetite). MOST doctors who I’ve gone to, after their whole spiel about how I’m “so fat, and need to go on a diet,” etc., despite my telling them that I eat very little (and sometimes have gone days without eating anything) insist that I’m fat “because of overeating.” Even when I’ve provided a copy of a letter (on his letterhead, with his phone number provided), which was FAXED to my PCP from another doctor – my staying at his house to render some priestly services, his seeing for over a month what I would (not) eat – his stating that I was eating very little, these doctors would STILL INSIST that my “being fat was due to overeating.” How FRUSTRATING it is to deal with these kinds of doctors, who insist on their own WRONG conclusions, and will NOT accept what the patient is telling them, NOR a letter from another DOCTOR!!! DUH-UH…

    But my MAIN HELL that I’ve gone through with doctors is due to my having sustained a botchery/butchery of a surgery in 1978, which I would NEVER have agree to have gone through had I been told the truth of the kind of cut they were going to make. I was LIED to as to what type of cut would be made – my being told a laparotomy – but I woke up to the painful effects from a BOTCHED up (left side) thoracotomy; botched up, because three ribs were broken, one puncturing the heart, another the lung, my finding out 20 years later that the three ribs were removed (after a chest x-ray had been taken, and a nurse practitioner asked me,” Why are you missing three ribs?”). The surgeon, (my never being told it would be a last year resident performing the surgery with NO attending surgeon), also sewed the intercostal muscles wrongly, so they pull on the spine. Although at first no medical personnel would tell me what happened, after my continued asking – my knowing something had gone very wrong – finally after my continued asking, I got the same story of what happened from so many medical personnel, including a night nurse who showed me the surgical report., she explaining the medical terminology. I was also told by many of these people, that Michael Petrezak (I don’t know if that’s the correct spelling of his last name), had to leave the OR to get the head surgeon to come to “fix” the damage he did.

    Long/short, with the consequent respiratory problems and pain, I wanted to see if an experienced chest surgeon could possibly do something to fix at least some of the damage, and requested to be given a copy of the surgical report, my telling the hospital people that I would sign anything stating that I would not file a suit against anyone for what had happened, (as I had no intention to sue), but was denied a copy of the report. I paid a lawyer to get the copy of the report, and found out from him that not only was there “no surgical report to be found,” but there were NO RECORDS whatsoever that I had ever been IN the hospital.

    Stupid me, I didn’t follow through on filing a suit, though the lawyer so much wanted to do this. I wasn’t into “getting money” but years later, realized I had made a BIG MISTAKE in not filing a suit, as besides having so many out of pocket expenses (BIG ones), from trying to go to “everyone” to get some mitigation of the pain – chiropractors, acupunturists, healers, naturopathics, physio and massage therapists, (including rolfers), NO one has been able to help me. I found I got more frustration from doctors, because many of them would NOT believe that my body get wreaked up in surgery. I even had one (IDIOT)) doctor tell me, (early May of this year), “You never had a thoracotomy.” After my telling him, “Yes, I did have a thorocotomy,” and his AGAIN telling me, “You did not have a thorocotomy,” for a third time I told him I did have a thoracotomy. When he again told me the third time that I didn’t, I asked him if he wanted to see the scar and he said no. So I politely told him, “I don’t think you can help me with anything,” and figured why even deal with such a numbskull.

    It’s sad that so many doctors have simply become a bunch of chemists and car mechanics, or see their patients, not as people experiencing this and that kind of suffering from this and that going on in the body, but see them as only as a “thing”; a machine made of various parts and chemicals.

    Sincerely,

    Rev. B. Radha-Govinda Swami