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Language exercises a powerful impact on medical care as the words
that physicians use with patients have the power to heal or harm.
The practice of medicine is shaped by the potent metaphors that are
prevalent in clinical care, especially military metaphors and the
words of war that bring with them unfortunate consequences for
patients and physicians alike. Physicians who fight disease turn
the patient into a passive battlefield. Patients are encouraged to
remain stoic, blamed for "failing" chemotherapy and sadly
remembered in heroic obituaries of lost battles. The search for
disease as enemy shifts the doctor's gaze to the computer and
imaging technologies that render the patient transparent, unseen
and unheard. Modern treatments save lives but patients can be the
victims of collateral damage and friendly fire. In The Language of
Medicine, Abraham Fuks, physician, medical educator, and former
Dean of Medicine at McGill University, shows us how words are
potent drugs that must be tailored to the individual patient and
applied in carefully chosen and measured doses to offer benefits
and avoid toxicity. The book shines a light on our culture that
deprecates the skill of listening that is, paradoxically, the
attribute that patients most desire of their doctors. Societal
metronomes beat rapidly and compress clinic visits into
stroboscopic encounters that leave patients puzzled, fearful and
uncertain. Building on research about physicians in practice, the
experiences of patients, stories of medical students as well as the
history of medicine, Dr. Fuks promotes an ideal of clinical
practice that is achieved by humble physicians who provide time and
space for listening, select words with care, and choose metaphors
that engender healing.
The renewal of medical curricula generally arises from emerging
pedagogies (e.g. problem-based learning), new technologies (e.g.
high fidelity simulation), or prevailing sociocultural forces (e.g.
complexity of health care delivery and team-based care).
Approximately 15 years ago, a team of physicians and administrators
sought to take this further: by considering the very nature of
medical practice and the patient-physician relationship that is the
context and conduit of caring and care, they restructured the
composition and function of medical education. This book,
Physicianship and the Rebirth of Medical Education, is the
authoritative publication on the philosophy, design, and
implementation of this new curriculum. From first year to
graduation, this book reimagines the education of medical students
in its entire scope. It discusses the epistemology of clinical
practice and pedagogical methods and addresses pragmatic issues of
curricular implementation. The educational blueprint presented in
the book rests on a new definition of sickness, one focused on
impairments of function as the primary issue of concern for both
patients and their care givers. This perspective avoids the common
shift of medical attention from persons to diseases, and thus
provides the basis for an authentic and robust patient-centered
mindset. The title of the book refers to a "rebirth." This implies
that there was a previous "birth." Indeed, the critical ingredients
of medical education were articulated historically and many
features emanate from a time-honored apprenticeship model. This
book recognizes in William Osler and his "natural method of
teaching the subject of medicine" the foundational elements for
teaching physicianship. The practice of medicine is indelibly
relational and, in turn, medical education is an intellectual and
an emotional journey that is rooted in clinical relationships. As
this book shows, medicine must unfold in the context of patient
care; patients, not diseases, should be the center of attention.
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