Letters to the Editor
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MEDICAL INSPIRATIONAL LECTURE 1
"I appreciate the time spent by my doctor in examining me and the manner in which the examination was conducted." _ Dr Wong Heck Sing
The undergraduate medical curriculum has a new item _ a medical inspirational lecture series for the to-be third-year medical students embarking on their Elementary Clinics. These lectures are part of the Foundation Course offered to the medical students which aims to equip them with clinical, communication, writing and presentation skills necessary for the practice of clinical medicine. In these lectures, distinguished alumnis are invited to share with the students their life and professional experience, and advice them on handling the course in Elementary Clinics.
There were two such lectures this year. Dr Wong Heck Sing, the 1997 SMA Lecturer, gave the first on 30 May. His lecture highlighted the importance of "High Touch Medicine", his experience as a patient and goals for budding doctors to strive for. Dr Kanwaljit Soin gave the second one on 6 June, focusing on how to become a good doctor.
Below are excerpts from Dr Wongs lecture on "High Touch Medicine", his life as a patient and professional goals to strive for.
"High Touch Medicine"
On "high touch" medicine, he said, "How you learn your skills, whether in history-taking, physical examination, or in the ordering of laboratory investigations, will determine the standard of your foundation. I am sure you will be well served
if you follow a systematic and disciplined approach." Ambroise Pare, a pioneer in medicine, has said that Surgery is learnt with the hand and eye. Danaraj, another medical pioneer, taught us that medicine should also be learnt with the ear and nose. Of the four senses, the hands, the eye and the ear will play a more important role at this stage of your career.
"Let me go through each of the senses involved, in history taking and in physical examination. No patient will regard you as a doctor unless you are a good listener. More can be learnt about a patient from his history, than from any other mode of investigation. History taking requires patience and skill. You will acquire this skill through practice and experience.
"Physical examination involving the hand and eye comes under the euphemism of "high touch" medicine, a term coined to describe the practice of the art of medicine. Doctors today often tend to bypass high touch medicine, replacing it with
"high tech" medicine, using tools like machines and technology to do the work for them.
"To the student, nothing is as exciting and inspiring as watching well performed high touch medicine, highlighting signs that point to the diagnosis. To the patient, nothing is as comforting and reassuring as being subjected to skilled, high touch medicine. It inspires confidence and trust, and establishes rapport between patient and doctor. Confidence, trust and rapport in turn lead to compliance. That, ladies and gentlemen, is what good doctoring is all about.
"I urge you all to acquire the skill of physical examination when you do your elementary clinics. One can never tell when a critical situation will arise, and all you will have will be your clinical skills to rely upon, to make a decision.
"The clinical art of medicine is being fast replaced by technical aids an impersonal and often costly substitute. More and more doctors, to save time and to cater to more patients, cut short the physical examination in order to increase productivity. As a result the art may soon be forgotten from disuse and hence not taught.
"The study of man and his diseases is best done at the patients bedside. No two individuals respond in the same manner to the same affliction. Its management must therefore be done on a person-to-person basis, in fact, on a whole person basis for reasons I have just mentioned. We have had two great doctors, Osler and Pare separated in time, some three hundred years apart, both coming to the same conclusion, that the study of medicine cannot be done without the study of the patient himself.
"A person may be able to pass the theory pan of the medical examinations on book studies alone, but he will never become a competent doctor unless he studies bedside medicine as well. It is only at the patients bedside that one faces reality. How often are diagnoses missed because patients do not always present the classical symptoms or signs? Was it not Osler who said that studying patients without studying the books was like sailing a ship without charts, but studying books without studying patients was like never sailing at all?
"Your elementary clinics will form a vital part in your training. Do take it seriously. Remember that patients are people with sensitivities and needed to be treated gently and with compassion. Spend as much time and as often with them but at the same time not at the expense of distressing them. There is no better way to study medicine than to study the patient himself."
Life as a patient
He also shared his experiences as a patient. He said, "Now in the twilight of my years, my life has come a full circle. I have known life as a doctor. I am beginning to know life as a patient. I am in a better position to appreciate the importance of whole person medicine, and to having a general physician to oversee my general well-being. I appreciate the time spent by my doctor in examining me and the manner in which the examination was conducted. I have learnt to appreciate the importance of punctuality, and what it means to sit in the doctors waiting room, waiting to be seen. Things which doctors often consider trivial, do matter to patients. The extra few minutes spent in explanation mean so much to patients. If I, trained as a doctor, could derive so much peace of mind from my doctors reassurance, how much more would a layman benefit?
"Doctors tend to equate patients with normal people. They often forget that patients cannot remember what they are told and need written instructions even for very small matters. They forget that patients are more sensitive and tend to misinterpret careless statements or body language. I am mentioning all these because as doctors we tend to take many things for granted.
"Some time ago, I saw a movie about the life of hospital doctor. What this doctor has always regarded in his practice as routine preparation for colonoscopies becomes a nightmare for himself, when he has to undergo the same investigation for an intestinal growth. After recovery, in order to bring the message home to his medical students, he makes each one of them go personally through the same experience _ the so-called routine preparation for colonoscopy. You can be quite sure the students are the better for it, for the enlightening and disagreeably uncomfortable experience."
Professional goals to strive for
On goals to strive for, he said, "The fact that all of you were selected to do medicine is an indication of the high standards of scholastic achievements you have attained in school. That alone is no guarantee that you will do well enough in your profession to be respected, admired and emulated. Not all President scholars become the best doctors. Attitude to your profession, to your patients, to your fellowmen, to work ethics, to material rewards, towards continuing education, these are some of the determinants that go to the making of a great doctor.
"You have chosen a unique profession that allows you access to peoples lives in a most intimate manner. The opportunities for serving their interests are limitless. On the other hand the opportunities for serving ones own self-interests are likewise limitless. While we may not be able to change peoples lives on the scale achieved by Pare, we could and should make life easier for those whose care we are entrusted with.
"There are enough role models among your various University teachers for you to emulate. Fulfil your dreams of caring for the sick and comforting the suffering, in the way you have always imagined it should be. The medical profession can be the noblest of profession for the principled. Conversely it can be the most ignoble undertaking for the unscrupulous.
"The most important goal for every doctor is to strive for the ability to treat patient with compassion. In the words of Ambroise Pare:
DR WONG HECK SING