THE MODERN-DAY PHYSICIAN
No greater opportunity, responsibility, or obligation can fall to the lot of a human being than to become a physician. In the care of the suffering, [the physician] needs technical skill, scientific knowledge, and human understanding.… Tact, sympathy, and understanding are expected of the physician, for the patient is no mere collection of symptoms, signs, disordered functions, damaged organs, and disturbed emotions. [The patient] is human, fearful, and hopeful, seeking relief, help, and reassurance.
–Harrison’s Principles of Internal Medicine, 1950
The practice of medicine has changed in significant ways since the first edition of this book appeared in 1950. The advent of molecular biology with its enormous implications for the biological sciences (the sequencing of the human genome), sophisticated new imaging techniques, and advances in bioinformatics and information technology have contributed to an explosion of scientific information that has fundamentally changed the way we define, diagnose, treat, and prevent disease. This explosion of scientific knowledge is not at all static as it continues to intensify with time.
The widespread use of electronic medical records and the Internet have altered the way we practice medicine and exchange information. As today’s physician struggles to integrate the copious amounts of scientific knowledge into everyday practice, it is important to remember that the ultimate goal of medicine is to treat the patient. Despite more than 50 years of scientific advances since the first edition of this text, it is critical to underscore that cultivating the intimate relationship that exists between physician and patient still lies at the heart of successful patient care.
The Science and Art of Medicine Science-based technology and deductive reasoning form the foundation for the solution to many clinical problems. Spectacular advances in biochemistry, cell biology, and genomics, coupled with newly developed imaging techniques, allow access to the innermost parts of the cell and provide a window to the most remote recesses of the body. Revelations about the nature of genes and single cells have opened the portal for formulating a new molecular basis for the physiology of systems. Increasingly, we are understanding how subtle changes in many different genes can affect the function of cells and organisms. We are beginning to decipher the complex mechanisms by which genes are regulated. We have developed a new appreciation of the role of stem cells in normal tissue function and in the development of cancer, degenerative disease, and other disorders. The knowledge gleaned from the science of medicine has already improved and undoubtedly will further improve our understanding of complex disease processes and provide new approaches to disease treatment and prevention. Yet skill in the most sophisticated application of laboratory technology and in the use of the latest therapeutic modality alone does not make a good physician.
When a patient poses challenging clinical problems, an effective physician must be able to identify the crucial elements in a complex history and physical examination, to order the appropriate laboratory tests, and to extract the key results from the crowded computer printouts of data to determine whether to “treat” or to “watch.” Deciding whether a clinical clue is worth pursuing or should be dismissed as a “red herring” and weighing whether a proposed treatment entails a greater risk than the disease itself are essential judgments that the skilled clinician must make many times each day. This combination of medical knowledge, intuition, experience, and judgment defines the art of medicine, which is as necessary to the practice of medicine as is a sound scientific base.