The Art & Science of Being a Doctor

number of possibly relevant facts when encountering a particular

patient. This art is demonstrated by the ability to obtain a
relevant medical, family, and social history and to perform an
accurate and thorough physical exam to make a rapid and proper
diagnosis and to devise an appropriate treatment plan.

A doctor must know which questions to ask and how to ask them
of a patient in a respectful and non-threatening way. He or she
must also know how to interpret a patient’s subjective
complaints and concerns in light of that patient’s social,
physiological, psychological, and cultural make-up.

Different patients might have the same underlying disease

process, such as angina, yet present with very different
complaints, such as chest pain, lightheadedness, shortness of
breath, or gastrointestinal upset. Other patients might present
with the same complaint – a cough, for instance – yet have
different causative illnesses, such as asthma, infection,
pulmonary embolism, cancer, or gastrointestinal reflux. A
complaint of headache could indicate meningitis, migraine,
sinusitis, temperomandibular joint syndrome, temporal arteritis,
subarachnoid hemorrhage, or a simple tension headache.
Appreciating these varying presentations in different patients
relies on the diagnostic art within medicine.

The job of a good internist overlaps with that of a psychiatrist. A

clinician must appreciate the interaction of the psyche and the
body. He or she must be able to recognize and diagnose
psychiatric illness. Many internists feel comfortable prescribing
medications for uncomplicated depression and/or anxiety. For

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