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Dr. Tomaino's Blog

The "Art" of Medicine

May 31st, 2009
Science and technology are undeniably critical ingredients to improving the quality of healthcare and the delivery thereof, today. Add to that a role for “standardization”—treatment pathways and protocols—and hopefully best practices and acceptable cost of care is provided.

In a recent AAOS Now publication, Frank Griffin, MD cautions that a “Wal-Mart” model probably won’t work for medical care, however. He notes, “Science isn’t all it’s cracked up to be.”

“So what’s the problem?” he asks. He goes on to acknowledge a number of them:
• The [scientific] literature is simply too confusing.
• Rarely do all similar studies reach similar conclusions.
• Researchers are biased---they or their institutions often stand to gain financially or professionally from the results of their studies.
• Regional variations in patient expectations may exist.

He makes a very important point about a component of care that may be lost amidst Centers of Excellence, Institutes, and large scale offerings---particularly marketed in the current climate of “consumerism”.

The “Art” of Medicine.

He humbly notes that part of the art “is sorting through the mass of information and applying it to our individual practices.” He goes on to write that, “sometimes the best scientific study may not apply well to a particular patient for reasons that are not always evident to a layperson.”

Despite efficiency, patient individuality prevents mass-produced medicine, thus patients can’t go through the system like cars on an assembly line. Patients respond to diseases and popular treatments differently.

He underscores that “Part of the “art” is recognizing the individuality of [each] patient and respecting the fact that people are not all the same.”

“Medicine is too personal. It isn’t like buying a commodity.”

Another article in the same May issue of AAOS Now addresses the balance in Orthopaedic Surgery between High Technology and High Touch. Indeed, Dr Griffin appreciates the importance of the latter in providing remarkable care—

“By reaching out and touching their patients, doctors show compassion and solidarity with them. Patients begin the healing process simply by gaining a companion who is trying to help relieve their suffering. Doctors also encourage patients to participate actively in their care [and] have the authority to critique [their] participation and act as guides……The power to heal goes beyond curing the human body. Illness is not a biologic or physical entity alone”

“Science and technology alone can’t deliver the kind of healthcare that we want”, he writes. “Compassionate application of the “art of medicine” plays a role.”

Dr Griffin’s opinions reflect my own as well. Seems like a big task----and it is. But it goes hand in hand with the privilege of helping you feel better; all of you—not just your shoulder, hand and elbow.


Terry McCormick

As for the ‘WalMart’ approach, you would think that after so many years of practicing the ‘art’ of Medicine, that community would realize this isn’t the approach; not just the handful of Doctors like yourself.

In recent years, Doctors and researchers have tried to explain their approach, or lack thereof, to Autism as being VERY difficult because each child is affected differently. There is no cookie cutter solution. They act as if this idea is something new. It obiously isn’t. How many people are cured of their colds, infections, psychosis, broken bones, or cancer by getting the same care as their neighbor? Not very many. Even Doctors within the same specialty and the same office don’t use equal standards. Even the same Doctor may try one approach only to change. Isn’t that why it is called a Practice?
Many times when patients try to take their care into their own hands, they turn to the internet. The wide variety of websites offers so many different ‘diagnoses’ for each ailment that it is hard to differentiate. Often patients bring the info to their Doctor’s for some sort of exchange only to be told, “you can’t always believe what you read” or “anyone can post to the net”. If the average patient were to try and read a journal article, they may not get past the Abstract which may give the jist of the whole article, but it might not highlight something buried in the article that may help that ‘one’ person. Having that personal exchange with your Doctor, whether it be your Family Physician or a Specialist, is key.

When it comes to being sick, that can very truly be a specific physical abnormality. When it becomes an illness, it affects the body and the mind.
Thank you Dr. Tomaino for being so candid with all of us.


May 31st, 2009 @ 5:06 pm

Dr. Tomaino,

Thank you for your perspective -- as is common with your "vintage" of perspective, you have effectively described the balancing act required of today's health care consumer. I for one trust that their are many practitioners that have mastered the "science" part of the equation. However, there are far too few that care about, or even have the capacity or tempermant for the "art" part of the equation. Thank you Dr. Tomaino for illustrating to me the inimitable value of that rare combination of both qualities.

May 31st, 2009 @ 11:16 pm
maryann mazzaferro

Dr. Tomaino
you summed it up perfectly. Treating a patient
is respecting the fact that each is an individual,realizing that all people are different,the "personal edge" of medicine.But how many physicians take the time to truly explore this side of health care?
my healing process at Tomaino orthopedics obviously went far beyond my shoulder recovery. it totally amzes me at times. feeling better physically and knowing that a physician truly care about you as a total person, extends that healing beyond the physical entity alone.
Thank you Dr. Tomaino for giving me the opportunity to feel better- all of me!! You are a true role model of compassionate care for other professionals to follow. Your philosophy on the "Art" of Medicine is one of a kind and so unique to Tomaino Orthopedics.

June 4th, 2009 @ 9:57 am

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