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

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Although we had waited a long time for a chance to prac- tice clinical medicine, our first experiences two years ago were met with varying degrees of trepidation. We had to adiust to dealing with patients instead of basic science professors. This transition shook some of us up because it meant our abilities to communicate and empathize had to be used as they had never been before. We each rushed ahead with our own personalized physician identity crudely created from past daydreams and old novels. We treated patients and we related to them with varying degrees of success. In our haste we did not see ourselves developing into the doctors that we are now. Part of our development was of course due to our increased sophistication in clinical medicine, but so much of what we are now is due to the patient and the way he interacted with us. Not until Psychiatry did we have a chance to examine the physician-patient relationship as a prime mechanism in the for- mation of ourselves as doctors. On Psychiatry, with its less demanding schedule, we learned in depth not only about the patient as a person but ourselves as well. Alcoholics, who were handled so routinely on Medicine, became individuals capable of expressing and eliciting strong feelings when seen on Psychiatry. We began to understand for the first time how the patient was shaping out indentities. He was developing our sense of empathy as we listened and understood his agonies and failures, or he was hardening our receptivity as we heard his deceit and recognized it as such. While on Psychiatry many of us discovered contemporary problems that plague our society, but which had been far from us because of the cloistered medical school environment. We had seen the end result of social decay at Martland, but on Psychiatry we began to gain reasonable first hand insights as to why such a mess existed. We had long sessions with heroin addicts Cwho were upset because their I2 year old brothers were on dopej, abandoned children fwho told us about all the presents they hoped to received at Christmasl, teenagers on LSD Iwho swore that their minds had not been destroyed and that their attemped suicide meant nothingh, unwed mothers fwho claimed it would never happen againj, and Viet Nam veterans Iwho talked unintelligibly through a psychotic hazel. Many of us had been hardened by the cheapness of life as we found it in Newark. Psychiatry served to remind us of how tremendously deep and complex each human life can be, and how valuable it is. ln effect, the patients seen on Psychiatry have confronted us with our own weaknesses as well as those of society. The psychiatric patient has increased our awareness of the world we are about to re-enter, but more importantly, he has led us to introspection and critical self-evaluation of our roles in medicine. GOOD-BY HARRY, WHEREVER YOU ARE!!! 46 DAVID ABEL, M.D. ...ij f I if 1 '. yfzgx it I I elsif! 524, pi.: yr , C. KNIGHT ALDRICH M. D., CHAIRMAN Ll... I tw if W, . W- .. I tl V sf WILLIAM A. LAYMAN, M.D, HAROLD S. FELDMAN, M.D., Ph.D

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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

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RTON L. KURLAND, M.D. 3 n 3 1 i L 1 we if aT R ' 1 LEO SHATIN, Ph.D. ALVIN FREIDLAND, M.D. ANGELO DANESINO, PhD. JOSEPH L. MORROW, M.D. ROBERT ADAMS, M.D. BY POPULAR REQUEST . , . KENNETH BERMAN, M.D. GOOD OL' HARRY