The Competent Clinician

In order to become competent clinicians, it is imperative that we first grasp the necessary knowledge for us to practice our craft. We have to learn human anatomy and physiology before we can hope to understand pathophysiology. We must learn to identify normal heart sounds which correlate with the flow of blood through the cardiac chambers before we can appreciate the abnormal early diastolic decrescendo murmur of aortic insufficiency.

Second, we must strive to perfect our clinical skills. The patient who presents with an acute thrombosed hemorrhoid no doubt welcomes our empathetic posture; but what he really requires is our skill and expertise to excise the painful lesion, remove the thrombus, and relieve the pain, before sending him on his way to do good in the world.

Thirdly, we must have the courage to admit our mistakes–both to ourselves, and to our fellow clinicians. How else can we continue to learn and perfect our craft?

Fourth, we must learn to approach the patient in an empathetic manner, with compassion. Suffering is a great teacher, and the act of witnessing suffering generates empathy in our own psyche–we learn compassion, i.e. “to suffer with” the patient. This does not mean that we must exude emotion. Osler talks about approaching the patient with equanimity. Doing so in no way negates or denies our personal feelings toward the patient.

It is indeed a tragedy that “psychological testing of medical students shows levels of empathy consistently decline during medical school and residency.” (“The Writing Cure” by Melanie Thernstrom, NYT Sunday Magazine, Arpil 18, 2004; p.44)