Bulletin Number Three 1983

first two years o f training and to attract suitable candidates for specialized training in Chemical Pathology. Adequate training w ill be provided in the new Department for higher diplomas such as MRCPath. In addition to Medical Officers, Scientific Officers play an important role in the development o f the subject. Training for Scientific Officers in Hong Kong is minimal at present. It w ill be a great advantage if a higher degree such as MSc in Clinical Biochemistry is available in Hong Kong and it is proposed that such a course be set up in the new Department. The second function o f the Department o f Chemical Pathology is to provide an investigation service to clinicians at Prince o f Wales Hospital. In addition to the usual investigations, it is proposed to set up a laboratory w ith special expertise to investigate complex metabolic and endocrinological problems. This type o f special service could be made available to other hospitals as well. A third role o f the Department is research. Continued research in Chemical Pathology is essential for better understanding o f diseases and improved service to clinicians in investigating patients. A ll members attached to the Department — Senior Lecturers, Lecturers, Scientific Officers, Medical Officers and Technologists —w ill be encouraged to undertake suitable research projects. Junior staff w ill be trained in research methodology so that they can make greater contributions when they move to other hospitals. Chemical Pathology investigations are mainly done on body fluids such as urine or blood. However, examination o f body fluids to understand what is happening in cells is like looking through the window o f a house in trying to assess all the activities w ithin. The analysis o f cells w ill therefore be an important new aspect in Chemical Pathology. The analysis o f cells which are readily available, such as red cells and white cells, w ill be developed in the new Department. —R. Swaminathan Department o f Medicine I know o f no better definition o f the objectives o f a Department o f Medicine, or for that matter, a teach­ ing hospital, than Nathaniel Faxon's: To advance knowledge, to train doctors and to set an example o f medical practice.' This is nomere abstract proposition, but one that states in unequivocal terms what must be the activities o f the teacher o f medicine and his purpose. As a clinician, I believe it should be turned around to 'Medical Practice, Teaching and Research' as I believe that patients surely must come first. Do the influences which are brought to bear on the medical student o f today really teach him the proper care o f the patient, which is medical practice? I f they do not, then there is something wrong w ith those who teach medicine. It is easy to overlook the fact that the applica tion o f the principles o f science to the diagnosis and treatment o f disease is only one lim ited aspect o f medical practice. The practice o f medicine in its broadest sense includes the whole relationship o f the doctor to his patient. It is an art based to an increasing extent on the medical sciences but comprising much that still remains outside the realm o f any science. The art o f medicine and the science o f medicine are not antagonistic but supplementary to each other. - There is no more contradiction between the science and art o f medicine than between the science o f aeronautics and the art o f flying. Now, the essence o f the practice o f medicine is that it is an intensely personal matter and one o f the chief differences between general or private practice and hospital practice is that hospital practice tends to become impersonal. A t first sight this may not appear to be a vital point, but it is, as a matter o f fact, the crux o f the whole situation. The treatment o f disease may be entirely impersonal; the care o f the patient must be completely personal. The significance o f the intimate personal relationship between doctor and patient cannot be over-emphasized. In a large number o f cases, diagnosis, treatment and management are directly dependent upon it and the failure o f the young doctor to establish this relationship accounts for many missed opportunities in the practice o f medicine. It cannot be said too often that the patient is a person and not a disease, and it therefore follows that the physician must have an understanding o f the in dividual and be able to consider his feelings. The ability to understand the individual depends on our sensitivity, our intelligence, our experience and our training but not on these alone. To understand the individual, the doctor must gather his experience and train his powers o f observation in a spirit o f charity, magnanimity and above all sympathy. Indeed a wise man once defined successful medicine as 'understand ing touched w ith sympathy' and this loses nothing if it is changed to 'successful medicine is sympathy armed w ith understanding'. It is not d ifficu lt to realize a little o f the courtesy, the intimacy and the understanding which is required. Although this properly takes place in the sick room o f the house, or in a consulting room, nevertheless we have to bring the same spirit into the wards o f our hospitals, where the patients need it just the same. It is utterly vital, by example, to show our students, as far as we possibly can, this art o f consultation. The care o f the patient demands, in addition to skill and knowledge, a lavish expenditure 8 RECENT DEVELOPMENTS