The Secret of Patient Care

The Secret of Patient Care is Caring for the Patient

by Dr Dan Waniek, MD
Copyright © 2006 danwaniek.org

Dennis L. Kasper, Eugene Braunwald, Anthony Fauci, Stephen Hauser, Dan Longo, J. Larry Jameson ( Eds. ) Harrison's Principles of Internal Medicine 16th Edition ( Two-Volume Set ) (Hardcover) 2004.
" Harrison " grew and became better with each new chief editor eversince they joked about " principles of internal medicine and details of neurology ". Now I like this two-volume set which makes the book less of a monster on my desk. Since this is the book I look into ( and even read :) every day since the glorious times of alma mater, maybe I can complain a bit too : Take for instance the for ever diminishing role of clinical knowledge - once the glory, the grammar and the vocabulary of medicine itself. Take " biomedicine " with international units standards waxing and vaning over the years. Take statistics, now compressed in overcrowded illustrations. Take the strange colors of this printing, take the for ever new and fuzzy dispersion of the atlas illustrations on paper which is anything but glossy, and so on.
However, the chief complaint and my main concern with the 16th edition is the advent of a new buzzword, " evidence-based medicine ". This is nonsense, at least for the old doctor I have become over the years. Should you really dismiss the search of an elusive diagnosis only because there isn't enough " evidence " for " judges " and " jurors " to be " convinced " ? I hope not ! Symptoms change with people who talk about for ever new " chief complaints ". Half of the disease tags I learned in Med School twenty years ago are now useless. Anyway, in those times, we were still aware of the hopeless task of sticking such tags on people who - in my time - seemed to be more than a collection of physical signs... Therefore, " internal medicine " - which has always been medicine itself, and as such, maintained a legitimate criterion in clinical knowledge - had a purpose in life. This was not conventional, but practical : patient care was all about caring for the patient... Younger hippocratic brothers, beware : Navigation using biomedicine, and this " Harrison " as a set of maps, is still possible. However - as sir Osler insisted in his times - without clinical knowledge, there is no navigation at all ! By all means, continue to spend your time touching, questioning, observing the patient ! By all means, continue to let blood flow into the real methods proven by millennia of patient care, even if you care more about your screens, protocols, smoke screens and malpractice insurance ! Care about the patient, even when you can hardly maintain the name " patient " any more ! You won't be afraid of charting unknown Oslerian seas... ISBN : 0071391401, BOBE-5254-REFS-0001, RANK : #52,651, 2680 pages, 16th edition.