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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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