My career in family medicine will be predominately clinic
based. Through my time at Toronto
Western Hospital I have been exposed to many unique and interesting patients in
the ambulatory clinic environment that, along with the helpful teaching and
guidance of my preceptors, have taught me a lot about medicine. However the strongest message that I will
take away from these experiences is the true art that medicine can (and should)
be.
Our clinical skills course in first and second year medical
school was entitled “The Art and Science of Clinical Medicine”, nicknamed “ASCM”. Although the inclusion of “art” in the name
tried to encompass the true nature of the physical examination being partially rooted
in experience and clinic judgement, the vast majority of our teaching focused
on the science. Our sessions focused on
interview techniques and patient care sometimes seemed half-hearted compared to
the then excitement of learning a new and complex physical examination maneuver. I spent significant time during my selective
working closely with Dr. Ho Ping Kong, who in my opinion truly embodies the art
of medicine. Through working with him I
have seen that the physical examination can be both informative and
therapeutic. Even when patients were
present for long-term follow-up appointments and had no current somatic
complaints, we would examine them (as appropriate) for signs and symptoms of
disease. As a clerk, I found that in
many of my rotations, we would focus on the imaging results, blood tests, and
other investigations before we would focus on the physical findings of the
patient. I have even been told that the
physical examination is “dying” and that in general findings on physical
examination are no more specific than flipping a coin. But here I saw that a hand, a touch, a look
can been more reassuring than simply affirming that the blood tests are
normal. After all, patients come to SEE
a doctor, not their testing results.
They value our opinion, which includes the way that we look at them
carefully, and the way that we lay our hands and our eyes. I was impressed in the ways that Dr. Ho Ping
Kong remembered important social aspects of his patient’s lives; he would specifically
ask me if I had asked one patient about her husband’s health, and another if I
had asked how her current financial situation was. To me, this is an imperative part of caring
for a patient: understanding who they are as a person and where they are coming
from. Physical health is only one part of this
piece, the rest is fleshed out in the art of medicine.
I will be starting my residency training in rural family
medicine on July 1st. I know
that a strong physical exam will be necessary for me going forward as the hospitals
and clinics that I envision working at do not have the sophisticated technology
and imaging capabilities of many urban sites.
I know that the “science” of medicine and how I apply it will be
different from many of the things I have seen training in Toronto. However I think that having the opportunity
to work closely with Dr. Ho Ping Kong is an excellent conclusion to my clinical
training in medical school as it has reinforced the necessity of focusing on
the art of medicine in addition to the science.
This is one of Dr. Ho Ping Kong’s strengths that he brings to every
patient interaction and is something that I will make every effort to
prioritize in my residency training when I start caring for my own patients. I started medical school with the goal of providing comprehensive
care to all of my patients and my time in ambulatory internal medicine at
Toronto Western has provided me with the tools to approach each and every patient
with the art and science of clinical medicine.
