Doctoring: The Nature of Primary Care Medicine

Paperback | July 15, 2002

byEric J. Cassell

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American medicine attracts some of the brightest and most motivated people the country has to offer, and it boasts the most advanced medical technology in the world, a wondrous parade of machines and techniques such as PET scans, MRI, angioplasty, endoscopy, bypasses, organ transplants, andmuch more besides. And yet, writes Dr. Eric Cassell, what started out early in the century as the exciting conquest of disease, has evolved into an overly expensive, over technologized, uncaring medicine, poorly suited to the health care needs of a society marked by an aging population and apredominance of chronic diseases. In Doctoring: The Nature of Primary Care Medicine, Dr. Cassell shows convincingly how much better fitted advanced concepts of primary care medicine are to America's health care needs. He offers valuable insights into how primary care physicians can be bettertrained to meet the needs of their patients, both well and sick, and to keep these patients as the focus of their practice. Modern medical training arose at a time when medical science was in ascendancy, Cassell notes. Thus the ideals of science--objectivity, rationality--became the ideals of medicine, and disease--the target of most medical research--became the logical focus of medical practice. When clinicianstreat a patient with pneumonia, they are apt to be thinking about pneumonia in general--which is how they learn about the disease--rather than this person's pneumonia. This objective, rational approach has its value, but when it dominates a physician's approach to medicine, it can create problems.For instance, treating chronic disease--such as rheumatoid arthritis, diabetes, stroke, emphysema, and congestive heart failure--is not simply a matter of medical knowledge, for it demands a great deal of effort by the patients themselves: they have to keep their doctor appointments, take theirmedication, do their exercises, stop smoking. The patient thus has a profound effect on the course of the disease, and so for a physician to succeed, he or she must also be familiar with the patient's motivations, values, concerns, and relationship with the doctor. Many doctors eventually figureout how to put the patient at the center of their practice, but they should learn to do this at the training level, not haphazardly over time. To that end, the training of primary care physicians must recognize a distinction between doctoring itself and the medical science on which it is based, andshould try to produce doctors who rely on both their scientific and subjective assessments of their patients' overall needs. There must be a return to careful observational and physical examination skills and finely tuned history taking and communication skills. Cassell also advocates the need toteach the behavior of both sick and well persons, evaluation of data from clinical epidemiology, decision making skills, and preventive medicine, as well as actively teaching how to make technology the servant rather than the master, and offers practical tips for instruction both in the classroomand in practice. Most important, Doctoring argues convincingly that primary care medicine should become a central focus of America's health care system, not merely a cost-saving measure as envisioned by managed care organizations. Indeed, Cassell shows that the primary care physician can fulfill a unique role inthe medical community, and a vital role in society in general. He shows that primary care medicine is not a retreat from scientific medicine, but the natural next step for medicine to take in the coming century.

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American medicine attracts some of the brightest and most motivated people the country has to offer, and it boasts the most advanced medical technology in the world, a wondrous parade of machines and techniques such as PET scans, MRI, angioplasty, endoscopy, bypasses, organ transplants, andmuch more besides. And yet, writes Dr. Eric Ca...

Eric J. Cassell, M.D., is Clinical Professor of Public Health at Cornell University Medical College. He is the author of a number of books, including The Nature of Suffering, of which the Journal of the American Medical Association wrote "should be read by everyone in medical practice or considering a career in medicine."

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Format:PaperbackDimensions:224 pages, 5.98 × 9.21 × 0.71 inPublished:July 15, 2002Publisher:Oxford University PressLanguage:English

The following ISBNs are associated with this title:

ISBN - 10:0195158628

ISBN - 13:9780195158625

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Table of Contents

ForewordAcknowledgmentsIntroduction1. What Is Primary Care?2. The Heavy Hand of the Past: Thinking about Diseases versus Thinking about Persons3. The Special Problem of Technology4. The Clinical Method5. The Clinical Method and the Patient6. Where Should Primary Care Be Taught--and by Whom?7. What Should Be Taught?EpilogueNotesIndex

Editorial Reviews

"Few books can define a discipline, review its history and philosophical foundations, and make recommendations for training and practice; this one can....It is a refreshing reaffirmation of the importance of patient-centered care in a country increasingly preoccupied with managed care and costcontrol at the expense of the doctor-patient relationship."--Canadian Family Physician