Article by: Joseph Maa
“Death is not the worst thing in the world, and to help a man to a happy and useful career may be more of a service than the saving of life.”
In 1927, Francis Peabody delivered a timeless message to physicians addressing the relationship of the patient and physician. In a remarkably prescient piece that is as meaningful today as it was before, Francis Peabody describes the art of treating patients. The art of treating patients, a complement to the medical sciences, he argued, has a distinct role in treatment of the patient whose space has been increasingly encroached upon by medical science.
Consequently, a result of his observation was the tendency for physicians to treat patients as diagnoses, isolated organs with pathology, and disregard the clinical picture as an “impressionistic painting of the patient surrounded by his home, his work, his relations, his friends, his joys, sorrows, hopes, and fears” and more as a “photograph of a man sick in bed”. The question arises whether this is a natural progression of the landscape of medicine, or rather the result of an indifferent attitude to treatment of the patient. In Peabody’s case, his stance on the position is clear: “Hospitals, like other institutions founded with the highest human ideals, are apt to deteriorate into dehumanized machines, and even the physician who has the patient’s welfare most at heart finds the pressure of work forces him to give most of his attention to the critically sick.”
Of course, it may be naïve to think this way. Peabody’s emphasis on obtaining a state of physical and spiritual homeostasis is nearly impossible in this day and age. However, I believe that Peabody’s intention in writing this piece was to speculate on the role of the physician in the physician-patient relationship, and encourage an attitude less reluctant to recognize that what he calls “psychoneuroses” in the absence of “organic disease”, what we normally attribute to medical treatment today.
Unfortunately, this article remains as applicable to use today as it did then because of the sheer amount of information that we yet do not know. Perhaps it is a more philosophical question than realistic one, but if we have not yet understood all aspects of the human body, then perhaps our negative connotations of “psychoneuroses” are unjustified. If we cannot find an organic cause of disease, that does not mean that it is not there. Furthermore, the proclivity of patients towards gastroenterologists over psychiatrists, for problems of the stomach due to stress, may be be partially due to the stigma that the field of psychiatry holds for most people. In the patient’s mind, it is more logical to assign pains of the stomach to disease of the stomach, and not the worries of the mind. However, if it isn’t the patient’s responsibility to make the distinction, then part of the responsibility falls to clinicians to recognize that fact. Also, because we do not understand the full breadth of complexity that the human body entails, Peabody makes the assertion that observation of the emotional state of patients is in line with being “scientific”. It is the absence of this willingness to observe the patient’s mental wellbeing that is “unscientific” in nature and runs opposite of the objectives of medicine.
Finally, I think that Peabody makes some well-reasoned, down-to-earth suggestions for doctors. Here are some of the considerations he took into account with a hypothetical patient with gastric ulcers: “Can he get [rest] best at home or in the hospital? What are the conditions at home? If you keep him in the hospital, it is probably good for him to see certain people, and bad for him to see others. He has business problems that must be considered.” I really personally enjoyed and internalized what Peabody spoke of as the transition when “the practice of medicine, and the treatment of disease immediately takes its proper place in the larger problem of the care of the patient.”
As a last thing to leave you with: “Disease in man is never exactly the same as disease in experimental animal, for in man the disease at once affects and is affected by emotional life… One of the essential qualities of the clinician is interest in humanity, for the secret of care of the patient is in caring for the patient.” Peabody’s article has certainly touched my heart and I highly recommend the short read to you.
Here’s the article link: http://jamanetwork.com/journals/jama/fullarticle/245777 🙂