Reclaiming the lost meanings of medicine.

We must recreate the system so that it recognises, rewards, reinforces and reimburses humanistic standards of medical care FOR SOME TIME, I have taught communication and rela-tional skills to medical students and physicians-in-training in an internal medicine residency program in the United States. What became apparent to me early on was that the humanistic, relationship-centred attitudes and behaviours being fostered in the classroom were not always finding their way into the clinic or onto the hospital floors. Sadly enough, this observation is supported by studies on patient–physi-cian communication. 1,2 In discussing this phenomenon with my students and colleagues, a common response emerged. They believe the relational behaviours taught in the classroom are not wholly credible in the " real world " of medical practice. Empathic attitudes and behaviours make little sense in terms of survival in residency training or success in practice. It seems as if these compassionate behaviours are being extinguished by a lack of incentive or reward in the system. Valued and rewarded instead are academic acumen, technical knowledge and skill, business savvy, and financial success. To better understand this situation, I began to study the " real world " of medicine more intently. Based on this examination, it is my impression that the fundamental problem in the current healthcare system is a lack of meaning. For the purpose of this article, " meaning " will be defined as the underlying beliefs, guiding principles, and defining philosophies that make up the professional ethic of medicine. What follows are my observations and thoughts, as well as a brief outline of my recommendations. Over the past century, there has been an insidious decline in attention to the philosophy of medicine. We have become less interested in or aware of the age-old values and ethical traditions of our healing profession. This claim is supported by the many studies demonstrating that medical training and professional socialisation, rather than developing and fostering humanistic attitudes and behaviours, actually erode them. 3,4 As a result, the core meanings of medicine have been subsumed by the current, dominating societal paradigms of business, 5 consumerism, 6 the information age, 7 technology, 8 and the legal system. Clearly, these paradigms are integral and necessary to world culture and modern healthcare, but problems arise when they control the healthcare system, directing the way we care for patients and relate to clinicians. Patient-care surveys reveal a steady decline in public …