The Science of Connection

Editorial EdItORIAL I began my career in 1994 as an interventional cardi-ologist, and I thought the world of medicine was totally mechanistic. My patient has a blocked artery; I have a stent and a statin in my toolbox; I fix the artery—end of story. There is nothing wrong with this approach in acute care. This type of medicine, the backbone of conventional medical education, can save lives. We were trained not to prevent disease but to treat acute problems. This training assumes patients are acutely ill and that the answer lies in some sort of " magic bullet. " They are not coming to us for preventive care. When chest pain is the chief complaint of my patient in the emergency room, I have three concerns on my mind: aortic dissection, pulmonary embolism, and, of course, heart attack. I want a history of the present illness, and I ask questions that are targeted to making a quick diagnosis. Are you nauseated? Have you vom-ited? Are you short of breath? If the diagnosis is a heart attack, I quickly prescribe the treatment: aspirin, blood thinners, and most likely an angiogram and stent. In most of conventional medicine, the primary aim is to arrive quickly at the diagnosis. This is especially critical in the acute care setting; rapid diagnosis leads to rapid treatment. The goal is to " lock down " and control physiology. The chief complaint and history of present illness become the critical aspects; the rest of the patient's story is truncated. Other information is commonly seen as superfluous to the diagnosis. This Cartesian model of medicine is excellent for life-saving treatment, but it functions in an acute disease care system. It has little to do with health and wellness or the treatment of chronic disease. Yet today, we apply this acute care model of disease management as we approach the treatment and management of chronic disease and the promotion of health and wellness. Over the past 100 years, the road of modern medicine has narrowed. The Carnegie Foundation commissioned the Flexner Report on medical education in the United States and Canada in 1910 for the advancement of teaching. The Flexner Report determined that certain practices were acceptable in medical education and others were not. As a result of the Flexner Report, restrictions were placed on what could and could not be taught in medical school. The Great Depression followed, …