A healing curriculum

CONTEXT: The banner of patient-centredness flies over many academic institutions; however, the practice and teaching of medicine remain oriented to disease. This incongruence is the result of an original Flexnerian dichotomy between the basic and clinical sciences and is maintained by a more recent distinction between disease and illness. One mind-set emphasises basic science and pathology pedagogically, whilst clinical medicine becomes a search for disease. The second introduces the patient as the focal point, underlining the personal and social contexts of illness. RESPONSE AT A CONCEPTUAL LEVEL: We must orient ourselves to a single central theme, namely, the well-being of the individual patient. Doing so does not deny the importance of the scientific understanding of biological function. Indeed, recent advances in genetics may permit a richer view of the individual as a unique product of genetic, developmental and experiential forces. The foregoing provide a coherent framework for a scientifically guided and humanistic medicine, which replaces the false dichotomies that have plagued medical school curricula with a congruent and stereoscopic view of medical education. RESPONSE AT A CURRICULAR LEVEL: We describe an undergraduate programme, entitled 'Physicianship', based on the fundamental premise that healing is the doctor's primary obligation. Explicit training in a specific clinical method, whose cardinal features include observation, attentive listening and clinical reasoning, emphasises the knowledge and skills necessary to effect this theoretical framework. The understanding of illnesses emphasises loss of homeostasis, whereas the physical examination highlights impairments of function. The educational experience is enriched with numerous opportunities for self-reflection.