"The Care of the Patient" - A Legacy

Francis W. Peabody

"One of the essential qualities of the clinician is interest in humanity, for the secret of the care of the patient is in caring for the patient."

Frances W. Peabody, MD, October 22, 1926

The quote which opens this blog is found in an essay derived from a talk Dr. Frances Peabody gave to the students at the Harvard Medical School, October 21, 1926.

Before his address, Peabody told his wife, "I am absolutely sure that this little lecture will be remembered long after anything of a scientific nature I have written has been forgotten."

After his presentation, Peabody's colleague, Dr. Joseph Pratt, was perplexed. He wrote, "His (Peabody's) address doubtless made an impression on the audience, but there was no evidence of unusual approval. In a few minutes the hall was emptied."

Despite the initial indifference to his address, the essay "The Care of the Patient" is the most cited, and revered, article in all of medical literature. It continues to impress all who read it, and it offers a paradigm for all physicians.

The element of caring receives virtually all the critique for which this essay is known, but there’s more which is worthy of attention. Peabody wrote, “The most common criticism made at present, by older practitioners, is that young graduates have been taught a great deal about the mechanism of disease but very little about the practice of medicine – or to put it more bluntly, they are too 'scientific,' and do not know how to take care of patients.”

That passage reminds me of a couple more quotes about the disparities between generations :

• “I see no hope for the future of our people if they are dependent on the frivolous youth of today, for certainly all youth are reckless beyond words…when I was   young, we were taught to be discreet and respectful of elders, but the present youth are exceedingly disrespectful and impatient of restraint.”
• “The young people of today think of nothing but themselves. They talk as if they know everything, and what passes for wisdom with us is foolishness with them.”

Who wrote those? When were they written? Dr. Phil, last week? Bill O'Reilley, in one of his scathing diatribes?

The first quote is attributed to the philosopher Hesiod, in the eighth century B.C. The second quote is from a sermon preached by Peter the Hermit in A.D. 1274.

The elders don’t escape criticism from said disrespectful youth. “They have lived many years. They are cynical, they tend to put the worst construction on everything. Their experience makes them distrustful and suspicious. Old age has paved the way for cowardice…,” is courtesy of Aristotle, 384-322 B.C.

The young doctors who, in 1926, were the targets of the older physicians disparaging remarks, have become the older ones who condemn the physicians of the next generation. Maybe the medical establishment isn’t going to hell in a handbasket; it’s following the natural order of humankind.

Maybe it doesn’t matter.

What matters was telling Tony that he was HIV positive, without crushing all hope. It was years before there would be drugs to fight it. Just a few months later, I had to tell him that his low T-cell count meant that he had full-blown AIDS. At the time, the diagnosis was still a death sentence. It mattered to him that it was me who told him, and that it was me he had seen for all the visits in between the bad news and the worse news. It mattered to him that he would see me at his next appointment, and the appointment after that, and the one after that. It mattered, very much, to me.

In Dr. Peabody’s words, “The good physician knows his patients through and through, and his knowledge is bought dearly. Time, sympathy and understanding must be lavishly dispensed, but the reward is to be found in that personal bond which forms the greatest satisfaction of the practice of medicine. One of the essential qualities of the clinician is interest in humanity, for the secret of the care of the patient is in caring for the patient.”