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The most competent physician of our world advises the patient to listen to an ignorant doctor who the patient thinks is very competent rather than to a competent doctor who the patient thinks is ignorant. He reason is that our imagination works for our good health, and as long as it is supplemented by remedies, it is capable of healing us. But the most powerful remedies are too weak when the imagination does not apply them.

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It is unsettling to find how little it takes to defeat success in medicine. You come as a professional equipped with expertise and technology. You do not imagine that a mere matter of etiquette could foil you. But the social dimension turns out to be as essential as the scientific — matters of how casual you should be, how formal, how reticent, how forthright. Also: how apologetic, how self-confident, how money-minded. In this work against sickness, we begin not with genetic or cellular interactions, but with human ones. They are what make medicine so complex and fascinating. How each interaction is negotiated can determine whether a doctor is trusted, whether a patient is heard, whether the right diagnosis is made, the right treatment given. But in this realm there are no perfect formulas.

The seemingly easiest and most sensible rule for a doctor to follow is: Always Fight. Always look for what more you could do. (...)

But our fight is not always to do more. It is to do right by our patients, even though what is right is not always clear.

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He said that knowledge was of little use without wisdom, and that there was no wisdom without spirituality, and that true spirituality always included service to others. As he explained many times, the essence of a good physician consisted of a capacity for compassion and a sense of the ethical, without which qualities the sacred art of healing degenerated into simple charlatanism.

Communication is not a one-way process. It's not just telling people things. ...[T]he first rule of communication is to shut-up and... just listen... and good doctors will do that. ...Good doctors will listen and explore the person's values and concerns, and... explore to what extent... that person want[s] to be guided... to be told what to do... and that's... appropriate to want... guidance from a trusted source. ...And ...make sure ...before ...that stage, you have ...genuinely laid out the options in a way that gives it balance. You haven't tried to manipulate them... into a particular direction. ...Very difficult ...but ...a worthy objective, and... having done that, it's perfectly reasonable to... then, give advice.

THE MAXIMS OF MEDICINE

Before you examine the body of a patient,
Be patient to learn his story.
For once you learn his story,
You will also come to know
His body.
Before you diagnose any sickness,
Make sure there is no sickness in the mind or heart.
For the emotions in a man’s moon or sun,
Can point to the sickness in
Any one of his other parts.
Before you treat a man with a condition,
Know that not all cures can heal all people.
For the chemistry that works on one patient,
May not work for the next,
Because even medicine has its own
Conditions.
Before asserting a prognosis on any patient,
Always be objective and never subjective.
For telling a man that he will win the treasure of life,
But then later discovering that he will lose,
Will harm him more than by telling him
That he may lose,
But then he wins.

THE MAXIMS OF MEDICINE by Suzy Kassem

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In a true and perfect form, imperturbability is indissolubly associated with wide experience and an intimate knowledge of the varied aspects of disease. With such advantages he is so equipped that no eventuality can disturb the mental equilibrium of the physician; the possibilities are always manifest, and the course of action clear. From its very nature this precious quality is liable to be misinterpreted, and the general accusation of hardness, so often brought against the profession, has here its foundation. Now a certain measure of insensibility is not only an advantage, but a positive necessity in the exercise of a calm judgment, and in carrying out delicate operations. Keen sensibility is doubtless a virtue of high order, when it does not interfere with steadiness of hand or coolness of nerve; but for the practitioner in his working-day world, a callousness which thinks only of the good to be effected, and goes ahead regardless of smaller considerations, is the preferable quality. Cultivate, then, gentlemen, such a judicious measure of obtuseness as will enable you to meet the exigencies of practice with firmness and courage, without, at the same time, hardening "the human heart by which we live."

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