On Proper Doctoring – Part Two


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We introduced you to the wisdom of Dr. David Mendel in Part One, with the promise of elaborating on some of his pointers in Part Two.  Let’s use his job description of a physician, laid out in Chapter One – beginning with one of my personal favorite subjects, the bedside manner.

“One absolutely essential ingredient of proper doctoring is the much-maligned bedside manner.  The best doctors acquire one over the years, but many never do … Now that we can cure many diseases, both doctors and public have replaced the wise avuncular physician of the past with the ‘intensive care whizz-kid image’.  We don’t need all that mumbo-jumbo when we have proper scientific methods, they say.  Bedside manners, along with other manners, are at a discount.  From the mechanistic viewpoint man is seen to be much like a motor car; you do a few tests, make the diagnosis, apply the appropriate treatment and all will be well.  Nothing could be further from the truth; the mechanistic approach is usually insufficient, and it requires the addition of an effective bedside manner to make it work … Reliance on scientific medicine alone is like lying on a one-legged couch.  The other three legs are wisdom, experience and caring.  For proper doctoring you need all four.”

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Secondly, the importance of common sense, that most uncommon virtue.  Mendel asserts that good doctoring is based on sound judgement, intellectual honesty, self-discipline, sensitivity, enthusiasm, compassion, care, memory, reasonable intelligence, and training.  There are enormous numbers of facts, and a good memory is invaluable, but failure of judgement is a more common cause of error than lack of information.  Most of us are not very good at putting ourselves in other people’s shoes.  The patient should sense that from your perspective, during moments of interaction, there is nothing else more important on your mind than his or her well-being.  You’re not the star of the show; the patient is.

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Thirdly, polish your performance.  Whatever your level of practice is now, enthusiasm and relentless pursuit of excellence is what will serve you and your patients best.  Aim to go on polishing your performance until you retire.  Your self-respect demands it.  Mendel cites the example of of the world renowned cellist, Pablo Casals, who still practiced slow scales daily at the age of 80.  Watch Casals give a master class, and see how he demonstrates the feel of practice beyond the notes on a page.  Doctoring is a science, but it is also a craft whose art must be continually learned and practiced to stay at the top of one’s game.

Mendel used the analogy of music to work on one’s craft because he first took up playing the flute at age 52 and practiced it daily until the age of 80.  When he retired from the practice of medicine at age 65, he studied Italian with the goal of interacting more with Primo Levi.  In that regard, he helped shape the meaning of active retirement.

One of Mendel’s favorite expressions was that a “cerebral bioassay”, or the ability to see patterns among different pieces of data or information, to achieve goodness of fit, was incomparably more valuable than the results of individual tests.  This easy and inexpensive read provides gifts that keep on giving.  David Mendel was a celebrated role model in his lifetime, and the reprinting of his book on Proper Doctoring provides an important opportunity to add his timeless pearls to one’s quest to be the best that one can be.

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