Clearly the science of medicine has progressed by leaps and bounds over the last twenty years—from computerized surgery to genetic modification. Yet medicine is more than just a science. It is also an art. As medical students complete their education, however, they may find that their training has been focused solely on the mechanics of diagnosis and treatment. While this scientific knowledge is fundamental to proper healthcare, it can overlook the importance of interacting with patients. In an attempt to refocus on how vital it is for doctors to consider their patients in full, Dr. Clifton K. Meador has written The Little Book of Doctors’ Rules. It offers simple and concise suggestions to humanize the practice of medicine.

In this book, Dr. Meador draws on his nearly sixty-year medical career for nuggets of advice with both compassion and humor. Although there may not be a defined medical disease behind every physical symptom, Dr. Meador reminds us that the reason behind a symptom may be found if a doctor observes and listens carefully to a patient. He believes an effective physician treats a patient, not just a patient’s disease.

The Little Book of Doctors’ Rules offers insightful rules that address a host of topics, which include developing a rapport with patients, treating dementia, and prescribing drugs. Designed for any healthcare professional, these short rules are easily understood and (mostly) non-technical. Here is a small sampling of Dr. Meador’s advice, from the sage and somber to the clever and sometimes controversial.

• While listening to a patient, do not do anything else. Just listen.
• Stop drug use in treatment whenever possible. If impossible, cease a patient’s use of as many drugs as possible whenever possible.
• Just because you know a lot of physiology, biochemistry, and anatomy does not mean you know anything about people.

If all you listen to are symptoms, then all you will hear from your patients are symptoms.

In addition to his own rules, Dr. Meador has included advice offered by some of the past giants of medicine. It is no coincidence that their words echo the message of this book, which gets to the true center of the healing arts.

Clifton K. Meador, MD is a graduate of Vanderbilt University School of Medicine. He trained at Columbia Presbyterian Hospital in New York and at Vanderbilt Medical School, where he completed a NIH fellowship in endocrinology.  After practicing medicine, he joined the faculty of medicine at University of Alabama School, where he was professor of medicine and then dean of the UAB School of Medicine from 1968 to 1973. He returned to Vanderbilt and Saint Thomas Hospital, serving as chief of medicine and chief medical officer of Saint Thomas Hospital from 1973 to 1998. He then served as the first executive director of the Meharry-Vanderbilt Alliance from 1999 to 2012. He is professor of medicine emeritus at both Vanderbilt School of Medicine and Meharry Medical College. Currently, Dr. Meador and his wife Ann Cowden, a well-known portrait artist, live in Nashville, Tennessee.

Contents

Acknowledgments, v

Introduction, 1

I. Rules for Developing Patient Rapport, 3

II. Rules for the Diagnostic Process, 13

III. Rules for Mental Status Examination, 29

IV. Rules for the Use of Medication, 33

V. Rules for Caring for Difficult Patients, 47

VI.Rules for Being a Professional, 59

Conclusion, 104

About the Author, 106

"Relate[s] to the more humane and hence efficient practice of medicine . . . while doctors can learn much from this book, all people in the health care chain—including patients—will find value in this jewel of medicine that does not contain a single technical term."

"Experienced physician Meador offers all involved with healthcare a commonsense, compassionate approach to working with patients . . . emphasizes the importance of astute listening and careful observation . . . Meador's rules will serve all seeking a guide to healing."

"Dr. Clifton Meador draws on his nearly sixty-year medical career for nuggets of advice with both compassion and humor . . . reminds us that the reason behind a symptom may be found if a doctor observes and listens carefully to a patient. . . . offers insightful rules that address a host of topics, which include developing a rapport with patients, treating dementia, and prescribing drugs. Designed for any healthcare professional, these short rules are easily understood and (mostly) non-technical . . . Expertly written, organized and presented, The Little Book of Doctors' Rules: A Practical Guide to the Art of Healing should be considered mandatory reading by all medical students, practicing physicians, and other members of the medical profession. The Little Book of Doctors' Rules should be considered a core and unreservedly recommended addition to college and university medical school library Health/Medicine collections and supplemental curriculum studies lists."

Introduction Since graduating from Vanderbilt University School of Medicine in 1955, I have witnessed many changes in the practice of medicine. The most dramatic changes have been the marked increase in specialists and the equally marked decrease in generalists—those physicians and other healthcare professionals in first-contact medical care, by which I mean general internists, family physicians, general practitioners, pediatricians, and nurse practitioners. These professionals see patients as they enter the healthcare system. At this initial point in the process, the nature and cause of a clinical problem is unknown. From my experience in primary care, and from discussions with colleagues, I have found that over 50 percent of primary care patients do not have a definable medical disease. They have complaints or symptoms but no medical disease. Nevertheless, while there may not a definable medical disease to explain every symptom, every symptom has a definable cause. Uncovering these hidden causes takes careful listening, observation, and a collaborative, trusting relationship between professional and patient. Identifying these hidden causes is the essential role of primary care and a major focus of the rules in this book. While this book is aimed mainly at those in primary care, it is meant to be used by all healthcare professionals. Divided into six Little Book of Doc Rules interior.indd 1 1/17/20 2:37 PM The Little Book of Doctor’s Rules 2 parts, it contains rules for developing patient rapport, the diagnostic process, mental status examination, the use of medication, caring for difficult patients, and being a professional. These rules provide guidance on how to learn the details of a patient’s lived life, establish a trusting relationship with a patient, and address the concerns of a patient. By seeing each patient as a human being instead of a collection of symptoms, healthcare workers of every variety can significantly improve the healthcare system, benefitting not only patients but also themselves.

“A brilliantly humane and practical guide for how to be a good doctor . . .

Wise, compassionate—and funny! There is nothing like it.”

—Samuel Shem, Professor of Medicine and Medical Humanities, NYU Medical School

"This book is so valuable because [author] Meador reminds doctors that they are treating a person, not a disease." —Maggie Mahar, author of Money-Driven Medicine