Fildes Park 

One of the most familiar and beloved images of the practice of medicine is The Doctor, an 1891 oil painting by Luke Fildes. This iconic artwork depicts a physician at the bedside of a sick child in a humble cottage, watched over by the child’s worried parents.

The doctor’s empathy and compassion are what defines this painting.

Fildes had once been at an ill child’s bedside himself, but without a joyful ending. He and his wife lost their 1-year-old first-born son, Philip, to typhoid on Christmas morning in 1877, and Fildes long recalled the devotion of the attending doctor, Dr Gustavus Murray (1831-1887).

Although stethoscopes and thermometers were essential clinical tools in the 1890s, no diagnostic instruments are seen in the image, and the only visible tools of healing are a basin and pitcher of water to cool the child’s fever. Medicine is thus reduced to ancient fundamentals: Observation and presence.

In today's world, medical care is increasingly mediated by tools and instruments. Advancements like the electronic health record have come to define the interaction between those providing care and those receiving it. And much of what was once done with clinicians’ eyes, ears, and hands can now be done more efficiently by machine. Increasingly, the opportunity for physical connection with patients is turned over to surrogates. The cost for this technological presence is disconnection from patients and a progressive dehumanization of their encounters with doctors, nurses, and other health care professionals.

Beyond technology are the economic forces conspiring to diminish human presence. Among them is the industrialization of health care. This trend is concerned with the movement of patients through clinical spaces with attention to efficiency and profit margins. Industrialization has reduced clinician-patient interactions to transactional units valued by volume. Individualized forms of human-to-human engagement are discouraged in favor of algorithmic checklists and scripted visits intended to drive survey metrics around the new cottage industry of patient satisfaction.

At the same time, medicine has become remarkably precise. Instead of looking at patients on the broader level like the doctor in Fildes’s painting, health professionals are instead trained to see collections of genes, markers, and proteins. In reducing the body to its most basic elements, we see diseases and their variants instead of people.

One of the striking visuals about this painting is the intensity of the doctor's gaze and his posture. His presence is clearly seen and felt. He was, as we say, "all in".

Presence is the mindfulness that one individual brings to an encounter with another. It’s a defining element of human connection. In medicine, it’s what happens when a clinician’s connection is untrammeled by a screen or other competing inputs. It’s the focus of mind, spirit, and intent around a moment in time that’s about another person and his or her most pressing problem. Presence, be it in a clinic exam room or with a friend over coffee, is a uniquely human gift.

Presence and other basic elements of human connection will emerge as defining features of a new generation of healers.

“The Doctor” challenges us to think about what good doctoring is.
Presence is a profound gift that doctors can give their patients. It is more than being physically present; it is stepping into the sacred space of another person's world.

Being fully present with patients is crucial for effective healthcare and a good doctor-patient relationship. A doctor who is not present may struggle to build rapport, understand the patient's concerns, and provide personalized care. This can lead to misunderstandings, missed diagnoses, and ultimately, a less positive patient experience.

Presence allows doctors to create a strong connection with their patients, which is essential for building trust and rapport. When a doctor is truly engaged and listening, patients feel heard and understood, fostering a sense of collaboration and shared decision-making.

Being present enables doctors to fully grasp a patient's concerns, including their feelings and experiences beyond just the symptoms they present. This holistic approach can lead to more accurate diagnoses and tailored treatment plans.

Presence is vital for effective communication. A doctor who is present can actively listen, provide empathetic support, and communicate information clearly and concisely.

Being present allows doctors to tailor their approach to each individual patient, recognizing that everyone's needs are unique. This personalized care can lead to better outcomes and a more positive patient experience.

This painting and all that it represents has been a direct and defining influence in the creation of Fildes Park Clinic and the years of work put forth by Dr Park in the community and nation at large.

In an age where health care seems devoid of the “care”, the staff and management at Fildes Park Clinic will continue to foster proper patient management with emotional intelligence.