There are qualities beyond pure medical competence that patients need and look for in their physicians. They want reassurance. They want to be looked after and not just looked over. They want to be listened to. They want to feel that it makes a difference to the physician

- Norman Cousins

The importance of becoming a doctor is not fully realized by the majority of students at the time of joining the medical course. Most of us took up medicine because that was considered the best choice at that time. The students are perplexed further by the negative attitudes of their own seniors, teachers and the complexity of the society we live. Having chosen medicine as a profession, the best way to deal with it is to go all out and not be contented with half hearted efforts at it. Happiness in life lies in doing something closest to our souls in the best possible manner. The following paragraph from one of the most respected physicians of our time emphasizes the scope of medicine in all its dimensions.

No greater opportunity or obligation can fall to the lot of a human being than to become a physician. In the care of the suffering he needs technical skill, scientific knowledge and human understanding. He who uses these with courage, with humility, and with wisdom will provide a unique service to his fellow man, and will build an enduring edifice of character within himself. The physician should ask of his destiny no more than this: he should be content with no less.

- Tinsely R. Harrison

The limits to medicine are best expressed by Trudeau:

To cure sometimes, to relieve often, to comfort always, to be able to do this, we require to cultivate attitudes that enable us to gain a broad knowledge of the subject of medicine, technical skills and the wisdom to use them well. In the dedication to his volume Underwoods, Stevenson wrote:

Jhere are men and classes of men that stand above the common herd, the soldier, the sailor, and the shepherd not infrequently; the artist rarely, rarelier still, the clergyman; the physician almost asarule. He is the flower (such as it is) of our civilization; and that stage of man is done with, and only remembered to be marveled at in history, he will be thought to have shared as little as any in the defects of the period, and most notably exhibited the virtues of the race. Generosity he has, such as is possible to those who practice an art, never to those who drive a trade; discretion, tested by a hundred secrets; tact, tried in a thousand embarrassments; and what are more important, Herculean 'heerfulness and courage. So it is that which brings air and cheer into the sick-room, and often enough, though not as often as he wishes, brings healing.

William Osier maintained that "The practice of medicine is an art, not a trade; a calling, not a business; a calling in which your heart will be exercised equally with your head...."

The science of medicine is easily learned in our training. To practice medicine as an art requires life long commitment and dedication. The practice of any art requires style. As we practice the art of medicine, develop a style or a manner of our own, a method by which we deal with our patients, students and colleagues. The ingredients of an ideal physician involve compassion, gentleness toward patients, a balanced disposition and coolness of mind especially under stress. The ability to communicate well is particularly important as most of what we do involves either teaching patients or students.

In his address to the medical students at Harvard Medical School in 1927 Dr. Peabody said:

"The practice of medicine in its broadest sense includes the whole relationship of the physician with the patient. It is an art based to an increasing extent on the medical sciences but comprising much that still remains outside the realm of any science. The art of medicine and the science of medicine are not antagonistic but supplementary to each other. There is no more contradiction between the science of medicine and the art of medicine than between the science of aeronautics and the art of flying. Good practice presupposes an understanding of the sciences that contribute to the structure of modern medicine, but it is obvious that sound professional training should include much broader equipment.

The treatment of disease may be entirely impersonal; the care of a patient must be completely personal. The significance of the intimate personal relationship between physician and patient cannot be too strongly emphasized, for in an extraordinarily large number of cases both diagnosis and treatment are directly dependent on it, and failure of the young physician to establish this relationship accounts for much of his ineffectiveness in the care of patients. What is spoken of as a clinical picture is not just a photograph of a man sick in bed; it is an impressionistic painting of the patient surrounded by his home, his work, his relationship, his friends, his joys, sorrows, hopes, and fears. Thus the physician, who attempts to take care of patient while he neglects those factors that contribute to the emotional life of his patient, is as unscientific as the investigator who neglects to control all the conditions that may affect his experiment. The good physician knows his patients through and through, and his knowledge is bought dearly. Time, sympathy, understanding must be lavishly dispensed, but the reward is to be found in that personal bond which forms the greatest satisfaction of the practice of medicine. One of the essential qualities of the clinician is interest in humanity for the secret of the care of the patient is in caring for the patient."

His instruction is even more pertinent today than in1927. The requisites of a profession are best summarized by Turtle and are particularly applicable to medicine.

The professional man is in essence one who provides service. But the service he renders is something more than that of a laborer, even the skilled laborer. It is a service that wells up from the entire complex of his personality. True, some specialized and highly developed techniques may be included, but their mode of expression is given its deepest meaning by the personality of the practitioner. In a very real sense his professional service cannot be separated from his personal being. He has no goods to sell, no right price for service, for what is the share of a man worth? If he does not contain the quality of integrity he is worthless. If he does, he is priceless. The value is either the nothing or it is infinite. So do not set a price on yourself. Do not measure out your professional services on an apothecary's scale and say only this for so much. Do not debase yourself by equating your souls to I what they will bring in the market. Do not be a miser, hoarding your talent and abilities and knowledge either among yourself or in dealing with jour clients, patients, flock. Rather be reckless and spendthrift pouring out your talent to all to whom it can be of service. Throw it away, waste it, and in the spending it can be of service. Do not keep a watchful eye lest you slip and give away a little bit of what you might have sold. Do not censor your thoughts to gain a wider audience. Like love, talent is useful only in its expenditure, and it is never exhausted. Certain it is that one must eat, so set what price you must, on your service. But never confuse the performance, which is great, with the compensation, be it money power, or fame, which is trivial.

All this may be considered too idealistic and impractical by present day standards and requirements. Everybody is equally concerned about the state of affairs in medicine today. The best way to deal with this problem appears to be to take care of one's own attitudes first. One should avoid being judgmental in dealing with others but show that right things are still possible, by personal example. Most of us start as ideal medical students, progress to near ideal postgraduates, good assistant professors, and finally metamorphose in to that ultimate achievement, the terrible professor. To maintain these ideals one must constantly struggle. Systems within which we operate are far from perfect and the personal influence of the teacher can to some extent compensate for the inadequate academic system. Cultivate the following qualities and propagate them. Some of the qualities are elaborated but others are self explanatory.

Qualities of a physician

• Enthusiasm
• A full personal knowledge of the branch practiced/taught
• Asense of obligation to teach
• The art of detachment
• A systematic method
• Thoroughness
• Honesty
• Attitude
• Appearance
• Humility
• Unreserved respect for excellence
• The conviction that right things are possible
• Certain degree of insensitivity or obtuseness to I criticism
• Willingness to take another opinion in the best interest of

1. Enthusiasm: One should have deep love for the subject and people. The desire to teach and care ' for people, without which all medical knowledge becomes cold and lifeless. Do not take up a subject that doesn't interest you for any length of time. By doing this, you are not only harming yourself but also the patients under your care.
2. A full personal knowledge of the branch taught: Not second hand information derived from books, but the living experience derived from I practical, well tested experience of a lifetime.
3. A sense of obligation: The feeling which impels a teacher to also be a contributor, and to add to the I stores of medical knowledge from which we so freely draw to teach and practice medicine.
4. Art of detachment: The faculty of isolating ourselves from the pursuits and pleasures incident to routine life and an emotional detachment to the I diagnoses we make. In all matters medical, what is right is more important than who is right.
5. Systematic approach: Unless one is a genius, a I systematic method is essential to learn medicine. I We must plan each day of ours in such a way that minimum time is wasted in unnecessary things. What we do daily is going to decide what we are I going to be at the end of a year or two. These few years as a student are going to make or break your I career. The present system of medical education does not foster competence and conviction in the student or future doctor. By the time the students finish their course; they are hardly in a position to I take care of patients because they have not spent enough time in the hospital. On many days in a I week, the student neither examines nor even talks to any patient. During their clinical years, students are not given any clinical responsibilities. In order to learn to deal with patients they should spend their time taking care of patients as house physicians or residents do. In the present system, it is not rare that by the time they finish their medical course, many find it difficult to communicate with patients.
6. Thoroughness: It is essential in all medical matters, be it a preparation for a talk, examination, or patient evaluation and management.
7. Honesty: The ability to admit a mistake, take another opinion or help when we are not sure requires courage and conviction on our part. We must conduct ourselves in an irreproachable manner so that not even the slightest doubt would be raised about our integrity.
8. Attitude: A doctor should be tolerant and patient. We should avoid judging people and taking sides because we undertake to take care of everybody irrespective of their origin or status.
9. Appearance: We must pay attention to appearance and behaviour as society often tends to judge us on this basis. A dignified and cheerful manner is particularly important in dealing with sick people
10. The grace of humility: Whatever excellence one achieves in medicine, there can never be perfection in it. There are always places to go and people to meet from whom we can learn to do better things. This realization makes us humble and without this quality, one stands out as an intolerable character.
11. Unreserved respect for excellence: Excellence in any branch of science or medicine, from whatever person, institution or country it emanates, should be respected and duly acknowledged. It is true that healthy competition or rivalry helps in achieving the higher objectives in medicine, but when carried too far it becomes counter-productive.
12. In the present atmosphere of medical practice and medical education, contributed to by the profession, the politician, the bureaucrat, it is easy to give up all hope of anything extraordinary and to become part of the corrupt system. Only the strong conviction that right things are still possible and the courage to withstand the pressures and put up with criticism helps to achieve the desired goals. These ideals should be maintained in spite of heavy odds in one's day to day work. The best time to start learning these attitudes is now when one is a student although it is never too late even for an older doctor. The attitude towards friends, classmates, seniors, juniors, patients and their families is an indicator of what one is going to be. This is the time one must learn to interact with people and patients. It is not enough to be a good student. One must strive to be a likable person in the college, hospital, and home. Once cultivated, these habits like bad habits are contagious. The best target is the students at various levels who are yet to be spoiled by exposure to the tricks of the trade of medicine today.

While examining and evaluating patients tact, sympathy and understanding are expected of the physician for the patient is no mere collection of symptoms, signs, disordered functions, damaged organs, and disturbed emotions. He is human, fearful and hopeful, seeking relief, help and reassurance. To the physician as to the anthropologist, nothing human is strange or repulsive. The misanthrope may become a smart diagnostician of organic disease. But he can scarcely hope to succeed as a physician. The true physician has a Shakespearean breadth of interest in the wise and the foolish, the proud and the humble, the stoic hero and the whining rogue. He cares for people.

- Tinsely R. Harrison

While we do our best we should be prepared to face thanklessness and even exploitation from some people. A certain degree of obtuseness or insensitivity to criticism is sometimes necessary in a professional.

Finally, all that is done in medicine is based on the conviction, that human life is valuable and human beings require to be treated with dignity and respect. As a doctor if your first reaction to the person is suspicion and hatred, one should not pursue a career in clinical medicine. Those of us who are religiously oriented should realize that our religion is medicine and all other religions pale before it. A good example is the best sermon.

(Anonymous) With the rapid advances that occurred in the last decade, medicine has become more remunerative and extremely competitive. The competitive atmosphere brought out the best in some individuals and institutions leading to superlative performance. However some institutions and individuals wilted morally under this pressure and took recourse to devious methods of dealing with the problem. For them, each patient is a prospect on whom almost all tests and few procedures can be done. They later call up the referring doctor and tell him or her how much money can be made on that patient. Unnecessary investigations, surgeries, or interventions have become commonplace. However the system of fee-splitting is destroying the soul of medical practice. This practice takes away all the trust that patients come to us with. This distrust will continue to grow if medicine is debased with such practices. The tragedy of life is what dies inside a man while he lives.