• U.S.

Medicine: Oh, My Aching Back

3 minute read
TIME

When a patient walks into a doctor’s office with the vague complaint, “I’ve got a pain in my back,” the success or failure of medical treatment often depends on the doctor’s first reaction. If he begins by looking past the patient, ignoring his pain and trying to find an interesting disease process, it is probably the fault of his early training. Most medical textbooks are little better than elaborate descriptions of diseases; they consider the patient only incidentally as a vehicle of disease, and his pain only as an aid in diagnosis (and not a very good one at that).

Last week, a new medical textbook was published which put the patient’s pains first. If a new generation of doctors adopts its humane attitude, even in part, many a patient of the future will be spared the numb feeling that his doctor is showing him less warmth and sympathetic understanding than a conscientious mechanic would give to the carburetor of his car.

In format, Principles of Internal Medicine (Blakiston; $12) is a weighty (8¾ Ibs.) volume, and unavoidably full of medical polysyllables. But its spirit is light, largely because of the personality of Editor Tinsley R. Harrison and the youthfulness (by medical greybeard standards) of the writing staff. Dr. Harrison, former president of the American Heart Association, is only 50; most of the associate editors and contributors range from under 30 to 45 and the average is well under 40.

In an introductory “Approach to the Patient,” puckish Dr. Harrison’s authors caution students (and general practitioners who may use the book for reference) that the patient comes first, with his aches & pains. Fancy modern laboratory tests and techniques are all very well, say the authors—but in their place. Laboratory data, they say, “are frequently surrounded by an aura of authority, without heed to the fact that the data are collected by fallible human beings who are capable of committing errors of technique, or who may misinterpret the most precise evidence . . . Even these data cannot release the physician from the necessity of careful observation and study of the patient.”

Since pain is what usually drives a patient to a doctor, the book opens with a discussion of pain itself, followed by detailed chapters on some of its commonest forms, such as headache and lower-back pain. Dr. George Pickering, Britain’s top headache authority, sadly records that only in the last 15 years has there been scientific experimentation to sort out the different kinds of headaches.

Although it contains more than 1,500 fact-packed pages, Principles of Internal Medicine gives doctors no encouragement to be dogmatic. Time & again its modest and inquiring authors say, in effect, “We don’t know much about this disease.” But even in those cases, they suggest, the doctor will do well to think of the patient before the disease—the whole patient, including his distraught mind as well as his aching back.

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