Development of the art of medicine

This paper reflects upon the art of family medicine experienced by one resident during an eight-month period of her two-year family medicine residency. The "science" of medicine, as experienced in medical school, is contrasted with the "art" of medicine fostered throughout the family medicine residency. Patients in all age categories, from neonates to those older than 90 years, were examined. The average number of patient-initiated encounters during the eight-month period was 2.3 per female and 2.4 per male. The five most common reasons for presenting were related to the skin, ears, throat, back, and requests for general "check-ups." According to McWhinney's taxonomy of patient behaviour, patient-initiated visits could be categorized into the following groups: 67.4% were limit of tolerance; 7.2% limit of anxiety; 8.2% underlying problems of living; 0.3% for purely administrative purposes; and 16.9% for preventive purposes. The experiences with four of the more memorable patients seen during the 12-month residency, presented here in personal vignettes, proved vital in moving the author toward her goal of becoming a well-rounded family physician.