The essence of medicine: genuine connections in practice

Remember organic chemistry?

I have a distinct memory of a rainy December day many years ago. I am standing in the hallway of the chemistry building at UC Davis, looking at a list taped to the wall of social security numbers and corresponding grades. I have just found my grade in organic chemistry, which is a C minus. For a visual person like myself, OChem (as we called it then) was difficult to grasp, especially the lab section: hours of fiddling with flasks, boiling, distilling, and condensing, only to end up with the wrong end product, or with the right product but unable to visualize on a microscopic level how I accomplished it. That C minus grade felt like the end of my premed plans. My professor walked by, recognized me as a frequent visitor to his office hours, and said jovially, “Have a good vacation!” That was a painful day.

But in spite of that terrible grade and against the advice of my premed advisor (“Don’t apply to med school; you won’t get in”), I did make it to med school, and now I’m at the other end of the journey. Looking back now, I am asking myself, what is the essence of medicine? I have doctored for over 30 years, and what is the true reason why I have kept going back every day? I know that medicine is not ordering tests or filling out forms for utility bill discounts or handicap placards. It’s not sending referrals. It’s not signing home health orders. It’s not remembering all the Medicare diagnoses. It’s not cutting open an abscess or pulling out a splinter or injecting a knee. It’s not refilling medications. I’ve seen thousands upon thousands of patients, run the experiment over and over, and there have been a lot of complications along the way: mistakes, triumphs, surprises, sadness, exhaustion, energy, optimism, and fear. But I can safely say, now, that my scientific analysis is complete, and I have learned how to synthesize the essence of medicine.

My product: It is a soft, squishy but highly stable and durable material that warms when touched, can create strong bonds, is never toxic, can stretch to surround and encompass, and has a wonderful shiny luster. What is it? It is the product of this interaction: a human being – a doctor – caring for, listening to, thinking about, and truly seeing another human being – a patient – and vice versa. That’s it. Let’s all keep cooking that up.

Jennifer Tillman is a family medicine physician.

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