Physician: How Science Transformed the Art of Medicine

Physician: How Science Transformed the Art of Medicine

by Rajeev Kurapati

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Overview

What happened that changed the priest—the revered healer of antiquity—into a person of science? How was the modern doctor made?

Physician is Rajeev Kurapati’s earnest attempt to answer this question and others central to the practice of medicine. For instance, how have the advances of medical technology influenced society’s perception of death? How do physicians balance thinking with feeling when dealing with critically ill patients? How do we meet the needs of patients seeking a personal connection to their doctor in what may seem to be an emotionally deficient medical landscape? Is it possible to overcome some of the compromises we’ve had to make along the way? What is the promise of modern medicine and its limitations? And notably—as medical care becomes more and more digitized and automated, will the medical degree—a universal badge of respectability—continue to hold value?

Dr. Kurapati, a practicing hospital physician, succeeds in gracefully exploring the depths of what it really means to be a doctor—and a patient—at this time in our human history, and his blueprint for building a stronger future of healthcare is an important and valuable one.

Product Details

ISBN-13: 9781632991454
Publisher: Greenleaf Book Group, LLC
Publication date: 02/01/2018
Pages: 322
Sales rank: 408,383
Product dimensions: 6.00(w) x 9.00(h) x 0.72(d)

About the Author

Rajeev Kurapati is a physician and the author of Unbound Intelligence. A health columnist for NKYtribune.com throughout 2015, he has also written articles pertaining to medicine, culture, and lifestyle that have been published in Slate Magazine, Smart Health Today, Mind Body Green, Life Hack, KevinMD, the Yoga Blog, The Good Men Project, and other outlets. Board certified in Family Practice, Kurapati has worked at St. Elizabeth Healthcare in Northern KY since 2008 and holds an MBA from the University of Missouri. He is the recipient of the 2008 Outstanding Teacher Award, judged by the physicians and medical students of St. Elizabeth Family Medicine Residency program.

Read an Excerpt

CHAPTER 1

THE NATURAL PHILOSOPHER

Fourteenth-century men seemed to have regarded their doctor in rather the same way as twentieth-century men are apt to regard their priest.

— PHILIP ZIEGLER, THE BLACK DEATH

The philosophies of one age have become the absurdities of the next, and the foolishness of yesterday has become the wisdom of tomorrow.

— SIR WILLIAM OSLER

As a modern doctor, I understand that I have no explanation for some diseases. Why, for example, do kids suffer from cancer? When a mother grieves as she watches her child succumb to a slow death from leukemia, what can I tell her?

As a physician who practices within the limits of science, the best reason I can offer is what scientific medicine provides. To the distressed parent, the mortality statistics may come across as a dispassionate rundown of clinical realities. I might say that perhaps the leukemia is the result of an inherited genetic mutation, passed on unwittingly from parent to child. But this explanation doesn't do anything to ease the guilt that a parent feels when a child is incurably ill. I can give nothing to this mother to console her sorrow-laden heart.

A similar explanation applies to many cancers in adults, particularly when these cancer-causing mutations are exacerbated by lifestyle and environmental causes such as smoking, exposure to chemicals, or too much time in the sun. But for kids, little is known about the causes of these mutations.

Yes, cancer can be caused by tobacco smoke or by an inherited trait, but research finds that most of the mutations leading to cancer crop up naturally. Every time a perfectly normal cell divides, it makes several mistakes when it copies its DNA. These are naturally occurring mutations. Most of the time, those mutations are located in unimportant parts of DNA. That's good luck. But occasionally they occur in a cancer-provoking gene. That's bad luck.

After two or three of these troublemaker genes get mutated in the same cell, they can transform that healthy cell into a cancerous one. What we know so far is that about two-thirds of the total mutations are random, slightly less than a third are due to the environment, and only five percent are hereditary — numbers that vary depending on the type of cancer. Lung cancer, for instance, is largely the result of environmental causes, while the vast majority of childhood cancer is a result of these bad-luck mutations. Of course, people can reduce their risk of preventable cancer by avoiding tobacco, eating well, and maintaining a healthy body weight, but the reality is still that most mutations arise naturally — we have no control over them.

Parents often think that, somehow, they're responsible for their child's cancer, but in actuality these cancers would have occurred no matter what. Even if we do narrow down what causes these genetic aberrations in children, we still fall short of explaining why kids have to suffer from these often fatal illnesses in the first place.

We might also ask why the immune system sometimes attacks our own tissues to cause rheumatoid arthritis, diabetes, lupus, or multiple sclerosis.

On the night she was diagnosed with celiac disease, a young woman in her early thirties lamented:

Tonight was the night of a nervous breakdown, a crying fest. I have never felt such a burden in all of my life. ... I met with the gastroenterologist today, had MORE blood work to confirm there are no other diseases at play with the celiac disease. I was asked to seek a nutritionist. I was also encouraged to find a support group for those with celiac disease ... and then spent an overwhelming amount of time buying stuff I can eat. It finally sunk in today that this will be the norm for the entirety of my life, and [I] cried of frustration trying to explain everything the doctor told me to my husband who is looking at me like I am crazy. I am scared of all the changes ... changes that could mean a healthy wife or days of sickness if we don't do things the right way. ...

Where modern medicine fails to find causes of certain illnesses, evolutionary theories try to fill the gap. Consider the painful condition gout. The best available explanation of why individuals are afflicted with gout is based around the evolutionary theory that humans and great apes have higher blood uric acid levels due to a specific genetic mutation that occurred about 15 million years ago. Uric acid, as an antioxidant, protects against aging and cancer. Logically, natural selection probably led to higher uric acid levels in the blood of our ancestors because protection against cancer and the ailing consequences of senescence are especially useful in a species that lives as long as we do.

English physician Thomas Sydenham, describing how a person with gout spends a restless night in A Treatise of the Gout and Dropsy in 1683, writes:

The patient goes to bed, and sleeps quietly, till about two in the morning, when he is awakened by a severe pain. The pain resembles that of a dislocated bone ... [and] becomes so exquisitely painful, as not to endure the weight of the clothes, nor the shaking of the room from a person's walking briskly therein.

Sydenham wrote with such clarity because he suffered terribly from gout himself. Even the evolutionary explanation of a disease, as logical as it may sound, doesn't pacify the individual's longing to know why they have to suffer.

In its current state, modern medicine remains ill equipped to answer the patient's questions, Why me? Why specifically me? Why should I suffer?

I'm trained to address, from a particular viewpoint based on scientific medicine, how the body works and why some people get certain diseases when others don't. Take strokes, for example. Uncontrolled high blood pressure, the consumption of fatty foods that raise cholesterol, and genes predisposed to atherosclerosis are major causes. But medical science, in its current state, struggles to explain why one individual over another succumbs to a stroke in the first place — why the self-correcting mechanisms of the body fail.

When faced with life-threatening illnesses like cancer, doctors are left to guide patients through a sea of uncertainty. Cancer is complicated, and it's difficult to compare one type or one particular stage to another. Compounding cancer's many consequences, many patients are also frustrated and scared, while family members frequently feel sad, guilty, and helpless. However hard doctors may attempt to coach a patient through this trying time, our efforts often fall short, failing to lend meaningful emotional satisfaction.

The scientific approach is bound by what we can perceive with evidence. Doctors are no different. When asked by a patient, Why did I suffer from a stroke, the answer might be, Because of uncontrolled blood pressure.

And after running few tests, a doctor's response to Well, why do I have high blood pressure? could be, It likely runs in your family.

Why does it run in my family?

Perhaps there's an evolutionary explanation.

Beyond a point, this line of Why me? questioning turns into a metaphysical preoccupation. Such philosophical pursuit is beyond the limits of scientific reason and is thus deemed outside the scope of a doctor's role. The decisions of a scientifically trained physician are driven by facts, not by what he or she happens to believe. When the conversation trails past the boundary of objective proof, the true answers to these questions become unsatisfying to patients: We don't know.

Scientists aggressively pursue the why of many things, although there's a limit to how far down the rabbit hole they're willing to go. When science, in all of its glory, can't explain why we have to suffer from an illness, patients become emotionally exhausted and inwardly defeated.

This is why the most difficult discussion physicians have with patients and their families doesn't involve laying out a detailed vignette of tests or procedures to diagnose an illness, or explaining a complicated surgery. In fact, most doctors find these exercises intellectually stimulating and professionally fulfilling. Instead, the most demanding conversation occurs when a doctor can't find the root of a sickness — when, despite their best efforts, medical professionals are left stumped. Perhaps even more challenging is determining what to say if all treatments fail. The life-altering, and in some cases life-ending, decisions made by patients and their families may literally hinge on the choice of words the doctor uses when delivering this news.

If a patient is admitted to the hospital with no meaningful recovery from terminal illness, a rookie physician might start by asking the patient's family, "What would you like us to do if your mother's heart stops beating or she stops breathing? Do you want us to do everything we possibly can?"

Most family members would, of course, instantly reply, "YES, do everything you can to keep my mother alive," when what they'd actually mean to say was, "Do everything you can to keep my mother comfortable."

After several years of grooming, physicians come to more fully realize the power behind the words they choose, learning how to steer patients and families toward truly digesting the impact of their decisions. Instead of using the phrase "do everything," a physician might delicately elaborate: "We could press on her chest, which could result in cracking her ribs, shock her heart, insert a breathing tube down her throat to put her on an artificial ventilator, or. ..." Usually this approach garners a much different response from the earlier knee-jerk reactions a physician might have elicited. In these instances, patients and families tend to listen intently as the seasoned physician offers an alternative: "If your mother decides she doesn't desire these aggressive, life-prolonging measures, we can let nature take its course."

When there's nothing left to be done by medical science, physicians may attempt to offer varying levels of comfort to grieving families. Still, most take meticulous care not to use phrases like "let God decide" or "the patient will be in a better place." No scientifically trained modern physician explicitly invokes supernatural forces in their treatment plans or deliberately uses the terms spirit or soul in their discussions. To ward off sickness, our medical education trains us to rely only on the abundance of medical knowledge at our disposal. Rather than illnesses being predetermined by any supernatural force, we know that our fates and the fates of our patients are determined by our genes, environments, lifestyles, habits, and decisions.

For the ancient medicine man, though, supernatural forces played the most deterministic role in patients' fates. The village healer of antiquity underwent tedious training to attain certain mystical powers. The medicine man would retire in isolation to "make medicine," that is, to learn the art of healing. Here, he'd fast, pray, and surcharge himself with intense penance or other occult practices to the point of ecstasy. In this state, he'd receive word from the gods through some phenomenon of nature to guide his future.

When he returned to the tribe, he would use his newfound "powers" to cure maladies. One popular belief of pre-medieval times was that illness involved losing part of our soul, so restoration was a key component of healing. The medicine man would enter into a trance to travel to the spiritual world, where he'd then be able to retrieve the soul of the ailing person and return it to them.

Essentially, illness was seen as a sort of personal consequence. Using his mystical powers, the medicine man would first strive to pin down which affliction visited the victim and caused the illness. It was usually a curse or a possession that took the blame. The village healer then warded off the affliction using his occult powers. In modern medical linguistics, we see the relics of this terminology when we regard illness as an invader and our bodies as a battlefield with the use of phrases like "attacked by disease" or "fighting off infection."

The visible, traumatic injuries were treated far more practically (and far more successfully) with bandages, stitches, or splints. When it came to non-traumatic internal ailments, however, our ancients had no clue.

The ancient Egyptians, for example, laid down a systematic method to deal with traumatic injuries. This method was meticulously inscribed in the oldest known surviving medical text, the Edwin Smith Papyrus, dating about 1600 BC.

The physicians classified injuries based on diagnoses they made by finger exploration, then followed a logical treatment plan. They even predicted the outcome of an injury based on the symptoms with surprisingly impressive accuracy. Each case was classified by one of three different verdicts: (1) favorable, (2) uncertain, or (3) unfavorable. A gaping wound in the head penetrating to the bone would be classified as "an ailment which I will treat." Whereas, for a wound penetrating to the bone and splitting the skull with the addition of fever and stiffness (of the neck), the classification shifted to "ailment will not be treated" surgically.

Knowledge of anatomy, the palpable aspect of our biology, was garnered largely by the observation of grievously wounded soldiers and animal dissections. Conversely, diseases that presented without apparent physical trauma were more likely to be diagnosed as being brought about by malevolent spirits or demons. In this case, it seemed like a logical part of the healing process for ancient physicians to invoke the deities of protection.

Primitive people firmly believed disease was sent by the gods as a punishment for moral transgressions, delivered either to the transgressor or to a loved one or confidant. They also didn't believe that sickness struck randomly. Disease was an act of retribution — deception, disloyalty, or theft might explain why someone was sick. With their supernatural beliefs, the medicine man had made-up theories for every aliment under the sun.

Healers often stumbled when attempting to cure diseases, but always played a necessary and important role in offering comfort. In that sense, ancient physicians were able to better perform their duties in this one aspect of care. Since ancient times through modern day, this remains the primary goal of a healer, as observed in 1800 by Dr. Edward Trudeau, founder of a tuberculosis sanatorium: "To cure sometimes, to relieve often, to comfort always."

Because healing was regarded as the outcome of personal, social, and religious beliefs in ancient society, treatment was not merely achieved through the use of therapeutics. Illness was a vital concern for the whole community — a collective suffering. It required rituals that ceremonially cleansed the polluted, offered reparations, and warded off ghosts. Rituals, incantations, and sacrifices were thus essential to this process, as were faith and therapeutics.

Many religions around the world maintain that illness is a manifestation of sin or misdeeds, and ardent followers of these religions continue to believe in such convictions to this day. To most modern doctors, however, disease is recognized as a biological phenomenon concerning only the individual who's suffering.

The result is that suffering can be a lonely fight of one individual against an unknown adversary, a solitary battle in an unchartered territory. When we suffer a stroke or succumb to cancer, physicians don't place blame on or attribute this to a moral trespass or the result of sin. This is true even for doctors who believe there are factors contributing to illnesses beyond the boundaries of human comprehension.

For a doctor like me, there's no room in modern medicine for concepts such as the soul or spirit in curing illnesses. This, however, is a radical departure from how it all started.

* * *

Religion and medicine originally shared a common orientation — both holiness and healing are words adopted from a common Latin origin meaning that which must be preserved intact. Such concepts ensured unity of medicine and faith — physician-priest-philosopher — the curer of bodies and the healer of souls. The delineations between the body, mind, and soul were nonexistent for our forbearers. In Greek philosophy, the righteous mind was a direct reflection of the heavens, and all learning was the path to spiritual fulfillment.

Most physicians in ancient times were temple priests who knew the reasons why things happened in nature, particularly to humanity. Mythological tales of gods and super-humans filled in many of the gaps: Sickness was a consequence of angering the gods, and no one dared to challenge that notion. Appeasing the gods was a way to cope with uncertainties and provided a seemingly convincing path to health and prosperity.

(Continues…)



Excerpted from "Physician"
by .
Copyright © 2018 Rajeev Kurapati.
Excerpted by permission of River Grove Books.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.

Table of Contents

Author's Note,
"Why Me?",
Part One — The Priest-Physician,
Ch. 1 The Natural Philosopher,
Ch. 2 Intellectual Hibernation,
Ch. 3 Breaking the Iron Mold,
Part Two — Brave New World,
Ch. 4 The Wondrous Machine,
Ch. 5 Paradigm Shift,
Ch. 6 Emergence of a New Sentiment,
Part Three — Balancing Science and Art,
Ch. 7 Studies, Studies, and More Studies,
Ch. 8 How Mathematicians Changed Medical Practice,
Ch. 9 The Obsession with Measuring the Human Body,
Part Four — The Big Shift,
Ch. 10 How the Heart Lost Its Esteemed Position,
Ch. 11 The Utopia of Curing Death,
Ch. 12 How Doctors Lost the Narrative,
Part Five — Necessary Compromises,
Ch. 13 Price Tags,
Ch. 14 The Unexpected Intruder,
Ch. 15 Medicine's New Mystical Force,
Part Six — The Future Doctor,
Ch. 16 Transcending Limitations,
Ch. 17 Man–Machine Symbiosis,
Ch. 18 How We Made the Modern Doctor,
To My Fellow and Future Doctors,
Notes on Sources,
Index,
About the Author,

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Physician: How Science Transformed the Art of Medicine 5 out of 5 based on 0 ratings. 8 reviews.
JeyranMain More than 1 year ago
The physician is a medical book referring to the human body and how medicine has advanced by getting physical. Healthcare providers who struggle to deliver a balance between both science and medicine can also benefit from this book. What made this book stand out was the differentiation between the relationships that healthcare providers have with their patients and how we can minimize human suffering. The book’s goal appears to be focusing on the depth of constructing a better correlation between perception, societies need of healing and healthcare. I enjoyed the literature very much as it was easy to understand and to follow. I also appreciated the author using his platform in order to discuss and point out the issues that exist in science today. Transcending limitations, I believe is a key issue here and the author executed the work flawlessly. I recommend this book to people that are in the field of medicine or are looking into new methods of healing. Healthcare providers and people interested in science will also enjoy this book.
ReadersFavorite4 More than 1 year ago
Reviewed by Romuald Dzemo for Readers' Favorite What are the essential traits that drive a physician in their practice? What makes a physician and patient relationship one that creates life and makes it possible for people to find meaning even in the midst of their suffering? In Physician: How Science Transformed the Art of Medicine, Rajeev Kurapati offers stunning answers to these questions and his style is very clever and compelling. The author shows how the concept of the healer has changed over time and how the spiritual, moral, and social aspects of being a healer faded as humanity began to experience new and advanced technologies. The reader will understand the history of medicine and the evolution of the art of being a physician. They will also learn about how the concept of a good physician changed with science, and the qualities that create a huge difference in the doctor-patient relationship. It is a priceless work, imbued with wisdom, and the author has put a lot of research into the work. He articulates in a way that allows the message to go straight to the heart of the reader. The writing is upbeat and the beauty in phraseology, the depth of insight, and the overall diction make it impossible to resist. Rajeev Kurapati shares his personal experiences with patients while drawing lessons from the history and practice of medicine. One learns that medicine is more than restoring the health of patients; it is more than science. It is relational! This book might have been written for medical professionals, but it has the advice and wisdom that ordinary people will find extremely useful. Physician: How Science Transformed the Art of Medicine is a tool capable of revolutionizing the art of healing.
ReadersFavorite3 More than 1 year ago
Reviewed by Ruffina Oserio for Readers' Favorite Physician: How Science Transformed the Art of Medicine by Rajeev Kurapati is a book with a subject matter that is so succinctly captured in the subtitle. This book answers the question: What does it mean to be a doctor and a patient at this time in history? Written by a professional in the field, this work of many years of research helps readers see how the art of care has evolved over the ages and how being a physician has changed with the changing times. In the author’s note that opens this discussion, he makes a statement that translates the thoughts and sentiments of anyone who has ever given due thought to what it truly means to be a physician: “Why is it that physicians and poets feel destined never to speak the same language? In other words, why is medical literature dry, devoid of rhyme and rhythm, and full of technical language, like an instruction manual describing the workings of a machine?” This book describes the author’s journey to find answers to this question and provides a comprehensive and healthy notion of what a physician should be . This is the work of a brilliant mind; thoughtful, and deeply understanding of the overall needs of a person. In this book, the author demonstrates with skill and mastery, and in a language that is very accessible, how modern medicine has morphed into something that could depend a lot on our advanced tools, neglecting some of the essential aspects of care, such as the emotional involvement in the patient-doctor relationship, the relationship between how we think and how we feel, and a lot more. This book brings together elements from the different disciplines, including psychology, mathematics, physics, and others, to create a positive and healthy profile of an ideal physician. It is interesting how the author weaves his personal experiences and medical history into this compelling work. Physician: How Science Transformed the Art of Medicine isn’t just for doctors; it’s a book with incredible wisdom and wonderful gems on medicine.
ReadersFavorite2 More than 1 year ago
Reviewed by Sefina Hawke for Readers' Favorite Physician: How Science Transformed the Art of Medicine by Rajeev Kurapati is a non-fiction health/medicine book that would appeal most to a mixed audience made up of young adults interested in working in the medical field, adults who work in the medical field, and all those who are interested in learning more about the relationship between doctor and patient. This book explores the history of how healers gave way to doctors, the role of technology in medical practices, the role of logic and emotions, and the limitations of current medicine. All of these aspects of medicine and more are explored through the perspective of a practicing hospital physician who seeks to both gain and share different views on medicine. Physician: How Science Transformed the Art of Medicine by Rajeev Kurapati is a well written book that managed to get me interested in the topic and the whole book with its very first chapter, titled “Why me.” This chapter is what made me interested in the book itself. This first chapter focused on a situation where the author was the physician for a patient that was suffering and looking to understand if there was a purpose to his suffering, and why it had to be him that was suffering. I found it interesting that it was not anti-depressants that helped the patient, but instead a priest. As a psychology graduate, I especially enjoyed the way Dr. Kurapati explored how doctors have to balance their emotions with their thoughts as it gave me a new understanding of the mindset that doctors have to employ, especially when working with terminally ill patients. Overall, I found this book to be a worthwhile read and it has changed the way I think about physicians entirely as it helped me to see them more as individuals who are not always perfect, instead of as just another doctor!
ReadersFavorite1 More than 1 year ago
Reviewed by Deborah Lloyd for Readers' Favorite The transformation of the practice of medicine from an art to a scientific endeavor is the main thesis of this fascinating narrative. Beginning with a real-life medical dilemma of a young man dealing with the physical ravages of diabetes, Dr. Kurapati illustrates how this shift affects today’s medical practices. A concise rendition of how the priest has been replaced by the physician, now trained to be devoid of the emotional and spiritual perspectives, is informative and thought-provoking. In Physician: How Science Transformed the Art of Medicine, written by Rajeev Kurapati, MD, there is a treasury of factual and inspirational knowledge. Dr. Kurapati demonstrates how not addressing the “why me” question, as well as other areas of human suffering, misses the essential issues for patients. Not only does he look at the past and the present, he also develops possible solutions for future patient-physician relationships. These solutions provide hope for a new reality in the healthcare arena. Although there is a great deal of information in this book, it is easy to read and digest. It is written in everyday language and can be understood by patients and physicians alike. The skillful writing of this physician engages the reader from the first page to the last. There is a clarity throughout the book, punctuated by heartfelt empathy. Rajeev Kurapati, MD, author of Physician: How Science Transformed the Art of Medicine, has presented a thorough and honest perspective regarding medical practice. There is a powerful message within its pages; this excellent book should be read by every patient and healthcare professional.
ReadersFavorite More than 1 year ago
Reviewed by Joel R. Dennstedt for Readers' Favorite Physician: How Science Transformed the Art of Medicine by Rajeev Kurapati achieves three major milestones of non-fiction writing. It is hugely important. It is masterfully researched. It is fascinating to read. Dr. Kurapati has done a major service to his profession by recapping the most cogent aspects of medicine’s rise to respectability, consistency, and applicability, including the earliest days of philosophical and religious-based misunderstandings, entrenched myths and dogmas, as well as genuinely good intentions towards healing the diseased and stricken. One might think this would take volumes, but it speaks to Dr. Kurapati’s keen ability to condense a mass of information into a coherent and highly accessible chronology that this book reads so easily and quickly, yet impacts one’s understanding with the power of revelation. Lest one think Rajeev Kurapati deals only with the past in his comprehensive book, Physician, the whole point of his efforts is to bring the reader into present awareness of current day medicine and the implications for its rapid immersion within a fast-approaching, almost incomprehensible future. In so doing, Rajeev Kurapati is compelled to return to medicine’s philosophical roots and the grand ideal of a holistic but personalized study, diagnosis, and treatment of individuals. While there is no going back to mystical incantations or denial of technological tools, the digital age promises an ability for internal monitoring and reporting and even experimentation and treatment that rivals past and current methods with quantum levels of improvement. The implications and ramifications of this profound development, along with some last-minute adjurations to his fellow doctors, are what concludes this brilliant author’s elegant summary of what it means to be a physician.
Anonymous More than 1 year ago
Being a nurse it’s so helpful to read this book and explore how a physicians brain works! I loved hearing how physicians respond to patients spiritually now a days compared to the past. This is such a great read and I highly recommend it!
FriendEP More than 1 year ago
Dr. Rajeev Kurapati's new release Physician: How Science Transformed the Art of Medicine is an engaging, well written account of how and why physicians should blend hard medical science with soft thorough perspective. Dr. Kurapati details real patient experiences in part to explore the evolution of ancient history's view of medicine as well as to nudge current and budding physicians to be more eclectic. Patient treatment is best addressed on all fronts, medical assessments leading to a working treatment plan woven together with genuine empathy. I am an Occupational Therapist and worked in pediatrics for decades. Occasionally I had OT students who were very engaging with the kids OR great at evaluation and assessment, but not both! The ability to blend the skill with the finesse is critical when working with children. I use to think only kids needed a customized, personal touch to entice them through their therapy which was sometimes difficult. In my late 50s however, I became an in-hospital patient and saw medical care through a different lens. The personalized approach along with great medical treatment is critical for everyone at any age! Listen and Treat!