Henning Mankell, who you might have heard of as the author of the “Wallander” books, has been diagnosed with cancer and has written a series of articles about his experience of the diagnosis and the treatment.
That same evening my wife, Eva, told me about something she had heard on the radio. A doctor had been talking about the art of medical treatment. “Nobody talks about ‘the art of medical treatment’ nowadays,” she said. “But that’s what it all boils down to, even so.” She is right, of course. When you have lived for almost 70 years, as I have, you have quite a wide experience of doctors met over the years. Doctors in different situations, in different countries. I don’t think I’ve ever come across an absolute dud, somebody I’ve run a mile to get away from. Obviously, some have been more capable than others; some have been impatient or preoccupied; others have seemed to have unlimited time available. But the doctors I remember most clearly are those who have displayed what can be described, certainly by me, as the innermost subtleties of the art of medical treatment. Alleviation, consolation, perhaps even cure, always involves a dialogue in which the patient and doctor learn how to talk to one another, and if possible create a continuity. Medication and other treatments are never enough in themselves. If the patient doesn’t understand what the doctor is saying, or if the doctor is unwilling or unable to interpret the questions and worries of the patient, the dialogue that is at the very heart of medical treatment will never materialise.
So, what is this? This art of medical treatment? There are some clues in Henning’s words – a dialogue; continuity; the creation of a relationship; the need to understand each other; opening a space to allow the patient’s questions and worries to be expressed and the ability to interpret them.
Why use the term “art”? Well, it’s partly to differentiate this aspect of medical practice from the science which is also required, and partly to refer to the craft, or skill, of the therapeutic relationship. These are people skills, communication skills which require non-judgemental, empathic listening. But I think the “art of medical treatment” is even more than that. It invokes a consideration of what medical treatment is.
What is the purpose of medical treatment? What is a doctor seeking to do with each and every consultation? Surely, it’s an attempt to assist a person to a better life. It’s not just about prescribing, or surgical interventions…..as Henning says “Medication and other treatments are never enough in themselves” – not that treatments are unnecessary – they just aren’t enough.
I feel the same way about diagnosis. It’s one thing to diagnose a disease, but it’s quite another thing to understand a person and their illness. We need our scientific knowledge to diagnose diseases, but we need our art of medical treatment to understand a person and their illness.
I’m struck by the relevance of Henning Mankell’s reflections for me at this point, as I reflect on my medical career, and am blessed to have patients share with me just what it is that they valued about their care over the years – you can read about that here. To summarise, it seems to me, they are telling me what they valued was my “art of medical treatment”.
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