Doctor and Patient

DOCTOR AND PATIENT* JEREMIAH A. BARONDESS, M.DA In choosing a topic for this lecture I have taken my theme from the motto of Alpha Omega Alpha, "Worthy to serve the suffering," for this motto goes to the heart of all medical education, research, and practice, namely, the interaction between doctor and patient. It is of this relationship that I shall speak to you. To make this interaction as productive as possible in terms of the relief of human suffering is the object of everything we do in medicine. The doctor-patient relationship is the central event to which everything else is tributary, and on the doctor's side of the equation it is primarily based on his regard for his patient as a human being. This has been the physician's orientation for centuries. Thus, Peabody's famous epitome that the secret of the care of the patient is in caring for the patient [1, p. 27] echoes the observation of the author of the Hippocratic Precepts, who said, "Where there is love of man there is also love of the art" [2, p. 309] and that of Paracelsus in the sixteenth century: "Love is the foundation of medicine" [2, p. 309]. That this fundamental humanism continues to underlie medical practice, that it remains the dominant force attracting young people to lives in medicine, cannot be doubted. The spectacular scientific advances and social pressures of recent years have not changed at all this basic truism: the business of medicine is the care of sick people, and the business of the physician is the care of the sick person. And yet, in recent years we have sometimes lost sight of this axial fact. The core relationship between doctor and patient is changing. It is being subjected to a number of stresses, some arising with the physician, some with the patient, and some with neither. I would like to examine with you the nature of some of these stresses, their probable effects in the reshaping of the * The Alpha Omega Alpha Lecture, delivered at the University of Puerto Rico School of Medicine, February 25, 1972. t Clinical professor of medicine, Cornell University Medical College; attending physician , New York Hospital. 394 I Jeremiah A. Barondess · Doctor and Patient doctor-patient relationship, and the areas in which we, as physicians, can help to resolve the problems which have appeared. Before subjecting you to my opinions about modern medicine and some of the problems it faces, I should introduce myself to you, so that you can take what I say with whatever size grain of salt seems appropriate to you. I graduated from medical school in 1949, and thus my own medical education and training were heavily influenced by the early days of the biomedical research revolution of recent years. I have had the good fortune to train in university hospitals and to have maintained a university hospital affiliation ever since. I have practiced internal medicine in a large urban center for 17 years and have remained a generalist, largely out of interest in the diagnostic challenges presented by the "undifferentiated" patient and because of a feeling that subspecialization tends to direct its interest more readily to the disease than to the broad human impact of the illness. I have had some experience in clinical investigation and have also been lucky enough to have had opportunities to consider and to function in relation to undergraduate training in internal medicine and the continuing education of the internist. I am firmly convinced of the abiding necessity of continued science support in medicine and of the absolute interdependence of science and clinical medicine. I maintain intact a prejudice of my early years—that is, to spend one's life as a physician is to spend it in the very best possible way; I believe that physicians generally are motivated deeply by a commitment to the relief of the sick and recognize bioscience as the underlying support for their efforts. Consideration of the pragmatic and emotional exchanges which operate in the engagement of patient and physician is hardly new. The flavor of the interaction has been considered by a number of learned men, including Sigerist [3, vol. 1...