The Ethics of Caring
An Approach to the Physical Examination
Diagnostic Medical Reasoning
Caring for the Patient
By Roger M. Cass, MD
Professor of Clinical Medicine,
University of Rochester School of Medicine and Dentistry
About the Book
The practice of medicine is an art, based on science.
—Osler (Aequanimitas 34).Care of the patient depends upon the making the correct diagnosis, which depends the clinical skills of the physician: astute observation, interview physical examination technique, and diagnostic reasoning ability.The diagnostic process is scientific. The physician gathers the data (patient’s symptom complex), completely and objectively, generates diagnostic hypotheses based on the data, then seeks to and verify or refute the diagnostic hypotheses by gathering more data (laboratory tests, images and diagnostic procedures). The symptom complex should be complete and clean, free of cognitive bias: framing bias and the bias of premature closure (medical terms and the diagnoses of other physicians). Data collection should be as careful, objective and scientific, as a researcher working in a laboratory (Morgan and Engel The Clinical Approach to the Patient 1969 W.B. Saunders Co. Philadelphia).Clinical Skills in Medicine was inspired by Morgan and Engel's text. It is based upon my Master Clinician notes, teaching clinical skills to second-year University of Rochester medical students. It includes the Ethics of Caring, Elson and Norman's research on the medical expertise, the medical philosophy of the great physicians, William Osler, the Hippocratic School, as well as contemporary medical philosophers, George Engel's Biopsychosocial model in practice, the clinical features of common psychological problems, and some clinical pearls I learned from my patients, my colleagues, and my reading.
About the Author
Dr. Cass is a a Professor of Clinical Medicine at the University of Rochester School of Medicine and Dentistry. He has taught medical students, house officers and fellows at UR Medicine for many years while remaining in full time private practice. He is the author of 20 medical publications and the textbook Rochester Medical Practice He is a recipient of the Univesity of Rochester Lawrence Kohn Teaching Award. Currently he is teaches Master Clinician Classes and inthe Primary Care Clerkship at UR Medicine.
© Roger M. Cass, MD. All rights reserved.