The Art of Clinical Medicine

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 1^st.  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.