Special CME Issue - West Virginia State Medical Association

Special Issue Commentary
Losing the Art of Medicine
Stanley M. Pamfilis, MD, FACC
Parkersburg Cardiology Associates
It has been said for centuries
that the practice of Medicine is an
art and I hold to this idea. While
Medicine may not be as aesthetically
pleasing as a painting or sculpture
I offer this consideration; the act of
patient evaluation requires a complex
creative process. Each physician
comes to this process with his innate
gifts and abilities. These talents allow
him to start the journey down the
path of learning the Medical art. The
student of Medicine is encouraged
to mature the development of these
talents by his teachers, mentors,
colleagues, and patients. During this
process he hones his talents through
long hours and years of training
and hardship to build a thorough
intellectual understanding of the
material. As the word “practice”
would suggest, he devotes a
lifetime building the experience
to refine this understanding.
The time he spends with
his patient is among the most
sacred human interactions.
When approached with openness
and skill, it can be the most
honest and cathartic moment
a patient will experience.
With this groundwork complete,
he then researches the specifics of
this patient encounter by gathering
old records, looking up test
results and often supplementing
this with additional library time
to narrow down or sometimes
expand the possibilities.
This complex process is necessary
to develop the unique encounter that
occurs with each patient contact.
As such it requires a complex
descriptive document to paint
the one and only picture of this
patient at this moment as revealed
to this artist. We humbly call this
the “History and Physical”. This
portrait will live forever to describe
that unique patient contact. It gives
anyone who reads it insight into the
very complex work already done
and leads to the appropriate next
steps in furthering the evaluation
and treatment of this individual.
It allows the writer to step right
back into the process even though
it has been a long time between
visits and furthermore acts as a vital
communication among physicians.
In order to create this unique
document, the language has to be
truthful, flowing, and descriptive
with word choices and nuance that
define both the patient and the artist.
This beautiful, healing, complex
process is now essentially destroyed
by the cold canned language of
electronic medical records. No longer
can we expect a patient’s presentation
to be clearly outlined or the artistry of
the practitioner to be manifest. This
paint by numbers product of EMR
will make everything ring the same.
And possibly the worse tragedy of
all is that artists in training, will see
this as the norm and will never learn
what pigments and brushes and
canvases have been stolen from them.
Objective
The purpose of this paper is to express my personal sadness about the permanent and detrimental changes to medicine that are
being forced upon us and that we as a group have no will to take control of our own profession.
8 West Virginia Medical Journal