No greater opportunity, responsibility, or obligation can fall to the lot of a human being than to become a physician. In the care of the suffering, [the physician] needs technical skill, scientific knowledge, and human understanding…. 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. [The patient] is human, fearful, and hopeful, seeking relief, help, and reassurance.
—Harrison's Principles of Internal Medicine, 1950
The practice of medicine has changed in significant ways since the first edition of this book appeared more than 60 years ago. The advent of molecular genetics, molecular biology, and molecular pathophysiology, sophisticated new imaging techniques, and advances in bioinformatics and information technology have contributed to an explosion of scientific information that has fundamentally changed the way physicians define, diagnose, treat, and prevent disease. This growth of scientific knowledge is ongoing and accelerating.
The widespread use of electronic medical records and the Internet have altered the way doctors practice medicine and exchange information. As today's physician struggles to integrate copious amounts of scientific knowledge into everyday practice, it is important to remember that the ultimate goal of medicine is to prevent disease and treat sick patients. Despite more than 60 years of scientific advances since the first edition of this text, it is critical to underscore that cultivating the intimate relationship between physician and patient still lies at the heart of successful patient care.
The Science and Art of Medicine
Deductive reasoning and applied technology form the foundation for the solution to many clinical problems. Spectacular advances in biochemistry, cell biology, and genomics, coupled with newly developed imaging techniques, allow access to the innermost parts of the cell and provide a window to the most remote recesses of the body. Revelations about the nature of genes and single cells have opened the portal for formulating a new molecular basis for the physiology of systems. Increasingly, physicians are learning how subtle changes in many different genes can affect the function of cells and organisms. Researchers are beginning to decipher the complex mechanisms by which genes are regulated. Doctors have developed a new appreciation of the role of stem cells in normal tissue function and in the development of cancer, degenerative disease, and other disorders, as well as their emerging role in the treatment of certain diseases. The knowledge gleaned from the science of medicine has already improved and undoubtedly will further improve physicians' understanding of complex disease processes and provide new approaches to disease treatment and prevention. Yet, skill in the most sophisticated application of laboratory technology and in the use of the latest therapeutic modality alone does not make a good physician.
When a patient poses challenging clinical problems, an effective physician must be able to identify the crucial elements in a complex ...