Sunday, April 26, 2009

Caring for the Patient

Francis Peabody in 1925, gave a lecture which was published in JAMA in 1927 called "The Care of the Patient". In it, he said,

"The good physician knows his patient through and through, and his knowledge is bought dearly. Time, sympathy, and understanding must be lavishly dispensed, but the reward is to be found in that personal bond which forms the greatest satsifaction of the practice of medicine. One of the essential qualitites of the clinician is interest in humanity, for the secret of the care of the patient is caring for the patient."

I bold that last section as that quote is one of the most famous in medicine. An article in the April 22/29 issue of JAMA comments on that famous lecture and article and points to the scientific studies of neural networks which show the science behind Peabody's point. Another article in that same issue points out that with the changes in medicine, including the use of hospitalists the type of relationship that Peabody speaks of is being lost when people go into the hospital and out of the hospital. These patients have little to no continutity of care between the hospital and the outpatient arena. The use of electronic medical records (EMR) and the emphasis on data collection that accompanies its use is also changing the emphasis from care to data collection. As we move forward with implementation of EMR, hospitalists and other innovations that are designed to improve health care in our country while controlling costs, lets not forget that losing the personal relationships in the care of the patient is likely to hurt both care and finances and lead to a more depersonalized system that few will be happy with.