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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