You who are on the road

Must have a 

Code

That you can live by

Teach your children

Crosby, Stills, Nash, Young

Tomorrow morning, I'll put on my white coat, and turn the doorknob to exam room #1, and walk in to see my first patient.  There will be 3 people in that room:  the patient, myself, and my "creed".  In his book, "Symptoms of Unknown Origin", Dr. Clifton K. Meador quotes Dr. Michael Balint:

"...every doctor has a set of fairly firm beliefs as to which illnesses are acceptable and which are not; how much pain, suffering, fears, and deprivations a patient should tolerate, and when he haas the right to ask for help and relief:  how much nuisance the patient is allowed to make of himself and to whom, etc., etc.  These beliefs are hardly ever stated explicitly but are nevertheless very strong.  They compel the doctor to do his best to convert all of his patients to accept his own standards and to be ill or to get well according to them"

Dr. Meador goes on to describe a hypothetical "physician's creed" in his book, a creed that he uses to dramatize the narrow biomolecular model of illness.  The hypothetical "physician's creed" reads:

"I believe my job as a physician is to find and classify each disease of my patient, prescribe the proper medicine, or recommend the appropriate surgical procedure.  The patient's responsibility is to take the medicine I prescribe and follow my recommendations.  I believe that man's body and mind are separate and that disease occurs either in the mind or in the body.  I see no relationship of the mind to the disease of the body.  Medical disease ("real" or "organic" disease) is caused by a single physicochemical defect such as by invasion of the body by a foreign agent (virus, bacterium, or toxin) or from some metabolic derangement arising within the body.  I see no patients who fails to have a medical disease" (Abram and Meador, 1976, Basic Psychiatry for the Primary Care Physician)

I think a useful exercise for all physicians, and especially allergists, is to make an attempt to put down--in writing--their own "creed"--our unconscious, but fairly firm beliefs that compel us to act the way we do.  

Here's my go at it:

I believe my job as an allergist is to find and treat allergic disease, and my broader role as a physician is to alleviate suffering in my patient.  I believe that all mucosal surfaces can be targets for allergic disease, and I won't limit my interest to the respiratory tract only.  I believe it's my responsibility to evaluate patients for  both IgE and non-Ige mediated disease.  I believe that compassion, technical expertise, and wisdom are the 3 pillars of a superior allergist-physician.  I shall show compassion to the patient, and listen intently to what he or she says since the history is the bedrock upon which most diagnosies are made.  I shall not prematurely disregard comments and symptoms I don't initially understand.  I shall be open to new modalities of allergy treatment, even if they don't fall within my usual treatment paradigm.

I believe that stress can significantly impact a patient, and I believe in treating the patient as an integrative whole of mind, body, and spirit. 

There you have it. I haven't thought alot about what I wrote.

I haven't edited it. Not even spell checked it.

It's a straight gut shot. Right from my heart.

My creed.

Later, Dude