Doctor and patient : $b Papers on the relationship of the physician to men and institutionsPeabody, Francis Weld
Science
Doctor and patient : $b Papers on the relationship of the physician to men and institutions
Peabody, Francis Weld
Medicine; Medicine -- Practice; Physicians
Meantime, of course, you will have been active along strictly medical
lines, and by the time your clinical and laboratory examinations are
completed you will be surprised to see how intimately you know your
patient, not only as an interesting case but also as a sick human
being. And everything you have picked up about him will be of value in
the subsequent handling of the situation. Suppose, for instance, you
find conclusive evidence that his symptoms are due to organic disease:
say, to a gastric ulcer. As soon as you face the problem of laying
out his regimen you find that it is one thing to write an examination
paper on the treatment of gastric ulcer and quite another thing to
treat John Smith, who happens to have a gastric ulcer. You want to
begin by giving him rest in bed and a special diet for eight weeks.
Rest means both nervous and physical rest. Can he get it best at home
or in the hospital? What are the conditions at home? If you keep him
in the hospital, it is probably good for him to see certain people,
and bad for him to see others. He has business problems that must be
considered. What kind of compromise can you make on them? How about the
financial implications of eight weeks in bed followed by a period of
convalescence? Is it, on the whole, wiser to try a strict regimen for
a shorter period, and, if he does not improve, take up the question of
operation sooner than is in general advisable? These and many similar
problems arise in the course of the treatment of almost every patient,
and they have to be looked at, not from the abstract point of view of
the treatment of the disease, but from the concrete point of view of
the care of the individual.
Suppose, on the other hand, that all your clinical and laboratory
examinations turn out entirely negative as far as revealing any
evidence of organic disease is concerned. Then you are in the difficult
position of not having discovered the explanation of the patient’s
symptoms. You have merely assured yourself that certain conditions
are not present. Of course, the first thing you have to consider is
whether these symptoms are the result of organic disease in such an
early stage that you cannot definitely recognize it. This problem is
often extremely perplexing, requiring great clinical experience for its
solution, and often you will be forced to fall back on time in which
to watch developments. If, however, you finally exclude recognizable
organic disease, and the probability of early or very slight organic
disease, it becomes necessary to consider whether the symptomatology
may be due to a functional disorder which is caused by nervous or
emotional influences. You know a good deal about the personal life of
your patient by this time, but perhaps there is nothing that stands out
as an obvious etiologic factor, and it becomes necessary to sit down
for a long, intimate talk with him to discover what has remained hidden.
Public-domain text, read in full here on John Shaqi.
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