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    Masterful Medicine
    Masterful Medicine
    Masterful Medicine
    Ebook180 pages2 hours

    Masterful Medicine

    By Paula S. Bauer, MD; Mark C. Horattas, MD; George L. Litman and

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    About this ebook

    Masterful medicine is the pursuit of perfection. Perfection may be unattainable, but the pursuit of perfection is available to all who have courage, determination and perseverance. Masters of any endeavor learn with practice to be the very best. They learn with equal measure from their successes, challenges, and failures. Masterful Medicine will inspire physicians to achieve a masterful practice of medicine, and to live a masterful life. This book describes the values and attributes that give meaning to masterful medicine. Masterful medicine is personal. A physician can practice masterful medicine without technology, but not without humanity. This book is a framework for the timeless skills, values, and attributes of masterful medicine, all of which can be learned and embellished. That is the beauty of masterful medicine: it can be learned and perfected over a lifetime. Medicine makes the world better. Masterful medicine makes medicine better.
    LanguageEnglish
    PublisherHillcrest Media Group
    Release dateJul 20, 2015
    ISBN9781634136488
    Masterful Medicine

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      Book preview

      Masterful Medicine - Paula S. Bauer

      System

      INTRODUCTION: THE ESSENCE OF MASTERFUL MEDICINE

      Michael E. Rindler

      Masterful medicine is the pursuit of perfection. Perfection may be unattainable, but the relentless pursuit of perfection is available to all who have courage, determination and perseverance. Masters of any endeavor learn with practice to be the very best. They learn with equal measure from their successes, challenges, and even failures. We hope this book will inspire physicians to achieve a masterful practice of medicine, and to live a masterful life.

      Masterful denotes the pinnacle of skills, applied to achieve exceptional results. Masterful physicians are not born with the skills and knowledge that make them exceptional. Physicians become masterful with experience and the accumulation of wisdom. Masterful medicine is practiced by physicians who possess the values and attributes that drive them to relentlessly pursue perfection. Physicians who possess these values and attributes practice masterful medicine, that drive to pursue perfection. This book describes the values and attributes that give meaning to masterful medicine.

      Masterful medicine thrives in very diverse settings. It thrives in eminent urban clinics and hospitals, in suburbs, and rural clinics. It thrives in Third World countries and backwater locations throughout the world. It also thrives in medical schools and residency programs where future physicians are formed. How is this possible? Masterful medicine is not about location, affluence, or technology. Masterful medicine is about the values and attributes that drive physicians to pursue perfection, no matter what setting they practice in.

      Masterful medicine is personal. It is about humanity, not technology. A physician can practice masterful medicine without technology, but not without humanity. They do not teach these things in medical school. What follows are timeless skills, values, and attributes of masterful medicine. All of these skills, values, and attributes can be learned and embellished. That is the beauty of masterful medicine: it can be learned and perfected over a lifetime.

      My four physician co-authors are all masterful physicians. They are exceptional clinicians, exceptional leaders, and exceptional people. We are friends, and we are colleagues. As Dr. George I. Litman points out in Chapter 42, friends are a profoundly important part of masterful medicine. We are incredibly fortunate to call each other friends, and to be collaborators in authoring this book.

      Medicine makes the world better. Masterful medicine makes medicine better.

      Note to Readers: Key points are contained in the box near the beginning of most chapters. Chapters also contain a vignette box: true stories intended to illuminate the message of the chapter. For simplicity, he is used rather than the more cumbersome he or she.

      THE MASTERFUL PRACTICE OF MEDICINE

      The masterful practice of medicine begins with listening and connecting with patients and colleagues in the quest to deliver the best quality care. Masterful practice is not a destination, but instead a journey. In that journey, masterful practice is the outcome of a lifelong pursuit of learning and giving back to medicine by teaching and mentoring. Masterful practice recognizes that even the best physicians need help and advice, and even the best physicians make mistakes. The masterful practice of medicine encompasses not only the pursuit of perfection, but also the necessity of effectively handling mistakes and failure. And learning from them.

      CHAPTER 1: LISTENING

      George I. Litman, MD

      Listening is challenging. In our practice lives, when so many distractions are occurring, it becomes increasingly difficult to take part in the process. Listening is not passive. As a physician, you must learn to be an active listener in order not to miss the clues and cues that the patient provides to you. Learn to not interrupt your patients.

      Listen to patients uninterrupted for a full two minutes.

      Observe the patient while he is talking.

      The best physicians are the best listeners.

      Studies have shown that the average physician interrupts the patient after only eight seconds. So here is the first effective listening dictum: Ask the patient What brings you here today? Do not interrupt the patient for two full minutes. Seems like a short time. Try it. The most important information will come in that period of time. The patient may hesitate. Keep a kind and considerate look on your face (hard as that may seem). You will be surprised at all that can be said in two minutes. After listening carefully, you can confidently direct the questions needed to make the diagnosis.

      Electronic Medical Record (EMR) systems make it very challenging for physicians to observe the patient and listen attentively. Extra care must be taken not to have the keyboard and computer as the center of your attention. Position the computer so you can see the patient. Become a proficient typist. Resist the urge to focus on the computer screen instead of the patient in front of you.

      During this active listening, watch the patient. Be like Sherlock Holmes and observe. Notice the speech pattern: Is the patient animated or despondent? Depressed or lighthearted? Happy or sad? Well-educated or from a less advantaged background?

      You have two ears and one mouth: there is a good reason for that. Use them in proportion. The history is the patient’s story. Eighty percent of diagnoses can be made after a careful history and physical examination. Take good notes. Patients will not mind you writing when they are convinced that you are attentive and concerned.

      Although time constraints can be frustrating, an effective diagnostician must listen with compassion and concern. Spend the time. Crack the case. Develop a good bedside manner. Masterful physicians are masterful listeners.

      Listen Before Judging

      A service chief stopped by his chairman's office on a Friday morning to warn her that one of the staff would be coming by to talk. The staff physician wanted to take Monday off without using a vacation day so she could take her father in to be admitted for chemotherapy. The chief thought the physician should have to take an official vacation day and not have a compassionate leave day.

      Sure enough, the staff physician came by to chat with her chairman. As they talked, it became clear to the chairman that it wasn’t the vacation day at issue, but whether, as a daughter, she should stay with her dad as he was admitted or just drop him off and come right into work. The chairman asked her a couple of questions: What does your dad want? and How are you going to feel Monday night if you don't stay with your dad all day? She replied, Well, that's just it! Her dad was a very stoic man who placed great value in work and career. She knew he would think she was being unprofessional by using a vacation day just to sit in waiting rooms while he went through the admission process. She was struggling with how to honor and respect his wishes while dealing with her own anxiety and worry over him.

      The chairman suggested that she make her decision on Monday morning: if he seemed fine, just drop him off, but if he seemed anxious, she could stay with him as long as he needed her. The department was well staffed and could easily cover if she decided to stay with him. And perhaps he'd be better supported if she went to visit him after work, once he was admitted and in his hospital room. She was instantly relieved and thankful. Taking the time to actually listen to her, asking questions to clarify what was happening and what the true issue was led the chairman to give helpful advice.

      CHAPTER 2: PATIENTS

      Jack H. Mitstifer, MD

      Physicians like to remind hospital administrators that the hospital cannot make money unless physicians write orders. We would do well to remember that physicians cannot write orders unless a patient first chooses us to provide care for them.

      The patient is why we are here.

      Be the physician your patient expects.

      Listen to the patient’s story.

      For most physicians, there was a time in their career when the answer to the question of why they went into medicine was patient care. Keeping medicine focused on patient care has evolved into a great challenge for all physicians. In financially stressful periods, some physicians can start to see patients purely as a cash stream. Once physicians begin to see patients as income generators, their moral compass can waver. Another popular hospital administration strategy encourages the medical staff to view patients as customers, dangerously shifting their goal from good patient care to the more superficial one of patient satisfaction. The goal must remain quality patient care while teaching physicians to deliver the care compassionately. Simply paying attention to a patient while recording in the EMR can be a monumental, yet essential, task.

      What do patients expect from physicians? They expect to be able to trust their physician implicitly. They expect their conversations to remain private. Prior to the Internet, patients assumed physicians possessed the requisite skills and knowledge; now they study rankings, quality scores and Angie’s List. They expect their questions to be answered in language they can understand. They want to know what is fact and what is speculation. They do not want a physician who shies away from giving an opinion when asked. Yes, the final decision needs to be the patient’s. That needs to be understood by both the patient and the physician, but an informed opinion can be of great value and provide peace of mind to both the patient and his family.

      Masterful physicians view patients as fellow human beings. As with any individual, they have a story to tell. Every patient deserves at least two minutes

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