Harrison's Principles Of İnternal Medicine

Harrison's Principles Of İnternal Medicine, Thorn, Adams, Braunwald, İsselbacher, Petersdorf, 63335, McGrawHill İrwin, Eğitim Kitapları, Kişisel Gelişim, Yabancı Dilde Kitaplar

PART ONE | THE PHYSICIAN AND THE PATIENT THE PATIENT AS A PERSON The same type of illness pre- sents in a variety of ways depending on the age, personali- ty, and social situation of the patient. Relevant here is the progressive change in social relationships, from a state of complete dependence on parent, family, and teacher, who must supply much of the historical details of an illness, to APPROACH TO THE PATIENT THE EDITORS greater opportunity, responsibility, or obligatonisv one of relative independence. At same time, there are en to an individual than that of serving as a physician. In variable degrees of maturation which involve the partial drives. These trends and their entific knowledge, and human understanding. The person modification during life experience are the basis of person who uses these with courage, with humility, and with wis ality; and deviations in these natural developments prevent dom will provide a unique service and will build an endur- satisfactory social adjustment. This alone may be the sole edifice of character. The physician should ask of reason for seeking medical help, but more often it com- treating the suffering, there is need for technical skill, sci- suppression of egocentric destiny no more than this and be content with no less. plicates other illness. Another aspect of illness that influences the physician THE ART OF MEDICINE In the practice of medicine the patient relationship is the real or implied significance of physician employs a discipline which seeks to utilize scien- disease in the mind of the patient. Any departure from ific methods and principles in the solution of its problems, good health involves a potential threat of physical disinte- but it is one in which, in the end, both science and art are gration or crippling disability, and even the most intelligent wedded. The crucial importance of understanding the sci- and best-informed patient should not be considered im- entific base of modern medicine is well known; the signifi- mune to forebodings just because refrains from men- cance of the of medicine is not as well appreciated. tioning them. In fact, most patients are more concerned Thus, to extract the telltale clue from a mass of conflicting with the possibility of being rendered dependent by illness physical signs and laboratory data the ones that of cru- than with the disease itself. It is especiaily important that cial significance, to know in a borderline case when to initi these fears be borne in mind when dealing with the elderly ate and when to refrain from a line of investigation or patient, who rarely unmindful that "the trap is laid" and treatment involves judgments based on "assimilated" expe-death is always near rience. Skill in accomplishing these necessities of medical art is not usually the outcome of laboratory study alone. The attitude of the patient approaching the doctor must always Intuition and maturing wisdom are called upon in devel- tinged, for the most part unconsciously, with distaste and dread; oping the more personal relations with the patient and the deepest desire will tend to be comfort and relicf rather than cure, and understanding and capacity to peer beneath surface moti- his faith and expectation will be directed towards some magical exhi vations into his behavior. Astute physicians will recognize bition of these boons. Do not let yourselves believe that however when the casual mention of an apparently trivial complaint smoothly concealed by education, by reason, and by confidential is a device for seeking reassurance regarding feared disor- frankness these strong elements may be, they are ever in any circum der such cancer or heart disease. They will at once know stances altogether absent. (Wilfred Trotter) when to probe the more intimate aspects of the patient's life, and when to leave them undiscussed; when to expressIllness also constitutes a threat to the individual's status a bright and reassuring prognosis, and when and how to in his social group. Prolonged invalidism during childhood tends inevitably to leave behind an excessive egocentricity Medicine is an art also in the sense that physicians can which may become the basis of lifelong neurosis, In the never be content with the sole aim of endeavoring clarify adult, illness often enforces a return to a posture of depen- the laws of nature; they cannot proceed in their labors with dency, a change usually accompanied by feelings of appre- the cool detachment of the scientist whose aim is the win- hension and discouragement, sometimes leading to frank ning of the truth, and who, in doing so, conducts a "con anxiety and depression. This explains a number of com- trolled experiment." Yet it is essential that they maintain mon psychologic defenses which the patient exercises objectivity in the study and care of their patients, for this is against illness. He may refuse medical aid; or, if he sum- n the patients' interests; nevertheless, they must use wise mons the courage to consult a physician, he may minimize judgment and must never forget that their primary and or even fail to mention the very symptom about which he is traditional objectives are utilitarian- the prevention and most deeply concerned. Then, too, there are persons whose cure of disease the relief of suffering, whether body emotional stability has been tenuous and uncertain, so that the position of dependency imposed by illness comes utter doubt and caution. or of

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