A Little Book of Doctors' Rules III
“This book is so valuable because Meador reminds doctors that they are treating a person, not a disease.”
These rules are drawn from extensive reading and over 60 years of teaching and practicing internal medicine. The rules are directed at those entering medicine and at those in practice who see patients in primary care or family medicine. The book is dedicated to Sir William Osler who admonished doctors to "'treat the patient with the disease" not just the disease. Large numbers of first contact patients do not have a definable medical disease but they do have hidden physical symptoms. Uncovering the cause of these symptoms of unknown origin requires careful listening and observation.
These 375 rules provide guides and suggestions for discovering the nature of these symptoms, emphasizing the need for an understanding, collaborative, and accepting relationship between doctor and patient. Listening to the "life narrative" of the patient often leads to an understanding of the origin of the patient's symptoms. Many diseases and causes of symptoms cannot be "seen" but must be heard from the patient's story and history.
"All cultures have their sages. The job of the sage is to codify and pass on nuggets of wisdom gained through experience, observation, and reflection. Dr. Meador is our sage and this little book of rules for clinical practice is just so: a collection of proverbs carefully rendered and trustworthy, offered as guidance for the clinical encounter that we may avoid folly, proceed expeditiously, render comfort, and see our patients safely through. My advice: read the entire volume over a week-end, then begin again, reading a few at a time over coffee before work, or at the end of the day – to great profit for yourself and your patients!"
John Leonard, MD
Professor of Medicine Emeritus,
Department of Medicine, Vanderbilt University
Former Residency Program Director, Internal Medicine
"This book is so valuable because Meador reminds doctors that they are treating a person, not a disease. With that in mind, he stresses the importance of listening to the patient, observing him, and even touching him.
First, listen for clues: "Most patients can tell you why they got sick. . . Let a patient ramble for least 5 minutes when you first see them. You will learn a lot."
Then, be sure you are facing the patient. "Learn to watch people's faces and eyes. Learn to watch their lower lip and then the upper lip."
Finally, "Always examine the part that hurts. Put your hand on the area."
Then, based on what he has heard, seen and felt, the doctor is in a position to begin ordering tests-- but not a battery of tests: "Use laboratory tests like a rifle, not a shotgun." Over-testing can lead to over-treating."
author of Money-Driven Medicine: The Real Reason HealthCare Costs So Much.