New Jersey College of Medicine - Journal Yearbook (Jersey City, NJ)

Page 48 text:

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Page 47 text:

BARBARA A. GLISTA, M.D. JOAN A. ARBOIT, M.D. J. EASTON, M.D. PAUL A. WINOKUR, M.D. Y 'T ' x M --Q1 , 51,55 1 1: - L I ' l .- . bg M Q ag, . ,, , . ' , V: V' 15,7 ,,u,w,w,???E, xg 5. gvql f' ii:-f , ' H 1- A A SF H 11, Evj5...a:Wv .1 .w if A - ,aiigf-f.Q 3 - um .. 'L I . LEONARD P. VITALE, M.D. T

Page 49 text:

The psychiatric care of the non-psychiatric patient-the patient whose primary condition is not defined as psychiat- ric-rieither is nor should be a monopoly of psychiatrists. ln- stead, it should be every doctor's iob. Perhaps this component is better termed the verbal side of medicine. Aside from history-taking and direction-giving, the verbal side of medicine is primarily concerned with the management of two major entities, anxiety and grief. Most of the physician's patients are anxious, their anxiety is usually a result of their symptoms, but often is a cause, or both a cause and a result. Many patients, and their families as well, suffer from grief in anticipation as well as in its direct expression. ln the immediate, or physician-relieving, management of anxiety and grief, simple reassurance is probably better then nothing, but it leaves a great deal to be desired. The scientific management of either requires much more than reassurance. it requires first of all empathy, which is not the same as sym- pathy, and is more than compassion. An empathic response, a proper empathic response, requires time, and that's the real rub. It requires time that connot be used as well or anywhere near as well by anyone else on the medical team as by the one physician who is perceived by the patient as primarily respon- sible for his care. For that reason, if for that alone, it is poor medicine to try to save time by immediately passing the troubled patient on to the psychiatrist or to the priest or to the nurse or to anyone else. Later, maybe, if referral is indicated, but only after the key physician has taken the time, the em- pathic time, to understand the indications. Unhappily, the verbal side of medicine is not easily measured, and it can virtually be avoided without risk either of malpractice or of looking bad on the chart. From this limited viewpoint, talking medicine is, relatively speaking, a luxury. And when money and manpower are in short supply, as at Martland, the luxuries are likely to be overlooked. Not that talking medicine really is a luxury. On the con- trary, l think it's the maior factor that stands between us- physicians-and a computerized, depersonalized medical technology of the future, with the physician spending all day at the console watching the printouts as a radiologist watches the viewbox. That threat, and all that's implied with it, make talking medicine no luxury. lt may be the key to our survial as a profession. By the time you finish your residencies, there will be many changes in the distribution of medical care. Some of these changes, such as the continuing trend towards super- specialization, are likely to reduce even further the emphasis on talking medicine. Martland, with all its limitations in both money and manpower, has already moved too far in this direc- tion. Perhaps tha1's why it's the place to start doing something about it. Knight Aldrich, M.D. Professor and Chairman 45