The goal of this book is to help young doctors achieve careers that are satisfying for them and beneficial for their patients and families. Nurses may find this useful as well.
The focus throughout is on the process of practicing clinical medicine rather than on information, and on how each student or resident can learn to develop their own natural abilities to achieve maximum success as a doctor.
The style of the book is relaxed and conversational. This is not a textbook but rather a series of reflections and discussions around the central themes involved in practicing medicine. The topics and presentations are based on the author's f our decades of practice in teaching hospitals while helping to train thousands of medical students and residents. The shared experience of caring for patients and the innumerable questions raised by these young doctors form the basis of the material.
A central premise of the book is that even the most complex skills of medicine can be broken down into discreet, readily learned tasks. Using this approach, each of the skills that contribute to excellence as a physician are made understandable and then applied in a practical manner to the care of patients and their families.
Differential diagnosis and medical decisions form the intellectual core of the book. Considerable attention is given to the roles of logic and Bayesian reasoning that are essential for managing the uncertainty involved in these two critical skills. The patient is always at the center and extensive use is made of clinical examples to illustrate the concepts, gradually increasing the complexity from the most simple situations to the most difficult challenges that confront doctors each day.
Several chapters focus on how to acquire the data that is necessary for diagnosis and therapeutic decisions, including how to obtain a history, how to perform the informal neurologic exam, and how to incorporate consultations, labs, imaging and electrophysiology into practice. The importance of recognizing and addressing patient concerns and psychological needs is continuously reinforced. Major attention is given to the many interpersonal interactions that are at the root of success in modern medicine. The role of doctors in the healthcare team is addressed in a practical manner with many useful hints on how to help optimize the team's performance.
In every chapter, the doctor-patient relationship is at the heart of the discussion. How do experienced doctors project compassion while caring for patients? How do they help patients understand their disease so that they can participate rationally in formulating the management plan? How can medical decisions incorporate patient and family preferences and tolerances, as well as take into account available resources? How does an experienced physician use medications, use consultants and select diagnostic tests, write useful notes, deliver bad news, help patients with psychiatric diseases, and avoid the innumerable pitfalls that regularly threaten to disrupt patient care? How does a physician communicate effectively with the patient, the family, with other doctors and the rest of the healthcare team? How does a physician learn from experience, including mistakes, manage uncertainty, and participate professionally in emotionally charged situations?
Practicing as a doctor is rewarding in many, many ways. It provides the opportunity to help people maintain their precious health, as well as to address challenges during their most vulnerable moments. The science of medicine is exciting and intellectually challenging. Participation in a healthcare team provides opportunity for personal growth and comradery. The purpose of this book is to help young doctors recognize and acquire the intellectual and interpersonal skills that are needed to reach these rewards.
