Blog | Monday, July 29, 2013

Considering the effective clinician


Last week I gave Grand Rounds at U.C. Davis with the title, "Learning to think like a clinician." As I considered my choice of words I realized that Philip Tumulty's essay and subsequent book influenced me greatly. This Johns Hopkins master clinician wrote the essay, "What Is a Clinician and What Does He Do?" [Tumulty P. N Engl J Med. 1970;283:20-24.]

Three years later he expanded on this essay and published his classic book that is no longer in print, "The Effective Clinician." Here is a quote from that original essay:

"He is meticulous in accumulating the historical and physical data from the patient. His questioning of the patient is searching and incisive, like that of a wise barrister. ... His special interest is any human illness. His care of the patient does not end with the correct diagnosis. ... He is inexhaustibly capable of infusing into his patient's insight, self-discipline, optimism and courage. Those he cannot make well, he comforts. ... The things he works with are intellectual capacity, unconfined clinical experience and the perceptive use of his eyes, ears, hands and heart."

His use of the phrase "clinician" raised the term in my mind. I owned his book, and read it several times. Unfortunately, like my comic books, it has disappeared. But I did get a copy of the original essay.

So I use the term clinician because not all physicians become effective clinicians. This phrase has magical meaning to me. It encompasses the various skills that our patients deserve. Even though the article is 43 years old, the meaning in the article has not changed. We must think, use various skills, and connect with our patients. I suspect that were he alive, Dr. Tumulty would write eloquently about what we are losing. He wrote this abstract back then:

"A clinician is one whose prime function is to manage a sick person with the purpose of alleviating the total effect of his illness. The multifocal character of the impact of illness upon the patient and his family is stressed. Clinical evidence is the material with which the physician works, and a meticulous history and physical examination are paramount. The availability of more specific forms of therapy requires a clinician to be more of a scientist and, at the same time, more expert in clinical methods. Ability to listen and to talk, so that valid clinical evidence is gathered, anxieties are dissipated, and understanding and motivation are instilled, are the clinicians' greatest assets."

We need more clinicians. Perhaps making that point is sufficient. I can only hope so.

db is the nickname for Robert M. Centor, MD, FACP. db stands both for Dr. Bob and da boss. He is an academic general internist at the University of Alabama School of Medicine, and is the Associate Dean for the Huntsville Regional Medical Campus of UASOM. He also serves as a frequent ward attending at the Birmingham VA Hospital. This post originally appeared at his blog, db's Medical Rants.