The foundation of medicine is care

I recently wrote that “diagnosis is job number one.”  In sports, there are times when two teams share the number one position.  Each team competes to make it to the championship; and, ultimately, one team has to lose its top ranking.

In medicine, care and diagnosis share the number one spot, working together toward a common goal:  to promote health.  Some would say that, without care, the diagnosis is worthless.  Certainly, a careless approach to medicine is fraught with problems.

So, is care the number one job or is diagnosis the number one job?  I think the foundation on which all of medicine is built is care.

You have to care about the patient and his family in order to make an accurate diagnosis or formulate a complete differential diagnosis.  You have to care enough about the patient to spend the time and energy necessary to root out all of the pertinent facts.  Making an accurate diagnosis sometimes means working on the problem long after the patient has left your office.  Finding answers for those in need can be exhausting and demeaning.

When you are up against a seemingly unsolvable medical problem, you have to admit to your shortcomings, seek outside advice, and sometimes acknowledge defeat.  It’s not easy to tell a patient you don’t have an answer or cure.  Care is the number one job and it is caring that gets your doc through the difficult cases.

A diagnostician is one part scholar, one part detective, and four parts artist.  The artist who cares about his subject matter and the quality of his work is capable of creating masterpieces.  In the practice of medicine, that may mean going over and over your work exhaustively, refining every brush stroke until finally completing the picture.

As a patient with a difficult problem to solve, the process is often frustrating and disappointing.  It is your doc’s care and your knowledge of the diagnostic process that will help carry you through tough times.

Care and diagnosis are the champions of modern day medicine.  They share the number one spot, along with compassion, understanding, and partnership.

With the complexity of today’s world come outside forces that infringe on the doctor-patient relationship.  Insurers, government, and corporate America are all inserting themselves between the doc and his patient.  It is incumbent upon all of us, patient and doc alike, to work hard to keep those forces from breaking the partnership between patients and their docs.

Continuity of care is a cardinal principle of family medicine.  A long-term relationship between doctors and their patients fosters a caring relationship where not only does the doc care for his patients but the patients care for their doc.  Continuity of care also fosters knowledge, compassion, understanding and partnership.  Find a doc who can care for you and for whom you can return that care and settle in for the long run.  You won’t be sorry.

Stewart Segal is a family physician who blogs at

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  • Anonymous

    Compassion is job one for physicians and nurses. I pick my primary care physician for their compassion. I ask myself would I want this physician to be the person to tell me that I was terminally ill? 

    • Anonymous

      “I ask myself would I want this physician to be the person to tell me that I was terminally ill?”   I like that.

  • jamesp

    I am amazed at how continuity of care is undervalued by so many americans. You;d think if a pt knew they would be changing Docs, esp PCP’s, they would at least try to have an understanding of their Dx, test results, meds, other Tx, etc.

    But over and over again, I have new pts who know none of these things- not even the name of their prior Doc so we can request records, and those who see a doc one time and dont go back b/c the tx “didnt work.”

    I bite my tongue but I want to ask these folks, “Didn’t your Doc say to come back if you weren’t better? Why didnt you do so?” Or worse yet, “You didnt do what he/she advised? Why not?”  I wish I had a dime for every time they reply, “Just did’nt.”


  • Anonymous

    I would rather have a diagnosis from a doctor who didn’t care than a doctor who cared and no diagnosis.

    • Kevin Nasky, DO


      Well said. All this online chatter about how
      “you have to care about the patient…in order to make
      an accurate diagnosis or formulate a complete differential diagnosis” is
      complete rubbish. The ability to take a thorough history, perform a physical
      exam, followed by appropriate workup, etc. does not rely on caring for the
      patient. One’s professionalism guides that process. You don’t have to care one iota
      about the patient to do the right thing, clinically, for him or her. One thing
      that makes physicians consummate professionals is our duty to apply the same
      standard of care to all our patients, be they someone we admire or someone we

      • Anonymous

        A doctor can also hide behind a charming personality to cover up inferior diagnostic skills.

        I don’t want to worry about being “liked” by my doctor.  I need to be able to trust that my flaws – however horrible they are – will not affect my doctor’s desire to provide quality medical care.

  • Elizabeth Mizioch-Crawford

    I had a PCP for over 20 years who saw me through college, marriage and the birth of my child. When I become disabled the office did not accept my new insurance and I had to look for a new doctor. Being chronically ill and in pain for the last 5 years and trying to find a PCP who held the same standards as my original doctor has proven to be futile. I would settle for a doctor who is knowledgeable about my illness and give up the compassion. Trying to find care and knowledge in one doctor has been exhaustive and unproductive. 

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