Today's entry is my 300th. That accomplishment tells me that I look forward to blogging about medicine each day. As a medicine blogger, I do not expect to run out of topics. As a physician I never run out of wonder.

While I understand the frustration that many physicians have with the current health non-system, I am still very happy that I decided to become a physician (and would do it again were I in college). I will rant daily about the problems we face - politically, legally, and socially. Nonetheless, we have a wonderful profession.

As I consider being a doctor, I marvel in the balance between the science of medicine and the art of medicine. Let me first comment on the science.

As an intellectually curious human being, I desire knowledge. As knowledge advances, we can often use that knowledge to help our patients. An example picked from my 30 years since starting medical school will illustrate my thoughts.

As a medical student we were taught about the acid hypothesis for ulcer disease. We treated patients with frequent small feedings and antacids. The most common surgery in the country was a Bilroth II (a vagotomy and gastrojejeunostomy). Over the next decade, the histamine 2 receptor was discovered and blockers developed. The introduction of cimetidine (Tagamet) had a marked impact, decreasing dramatically the need for ulcer surgery. After a few more years, the first proton pump inhibitor (omeprazole - Prilosec) was introduced, advancing our care even more. Meanwhile, a renegade researcher, Barry Marshall began pushing the hypothesis that a bacteria caused most ulcer disease. We now treat ulcer disease with an antibiotics concoction. The story all makes sense now, but who could have imagined it when I started medical school.

That story is not an isolated example. As I teach internal medicine on the wards, I draw from new findings daily. Medicine brings intellectual excitement daily.

Medicine also brings an emotional high. The art of medicine is fascinating. Although I have not done other jobs, I cannot imagine any other vocation where you meet someone (the patient) and they respect you and will tell you almost anything. Patients like physicians and physicians like patients. Our job is difficult, including delivering bad news, discussing end of life issues, and trying to steer patients to help themselves. The challenge of combining our need to maintain our knowledge base with the opportunity to effect patients in the manner we talk to them makes what I do a constant wonder. As I reflect on this past ward month, I remember several patient discussions about end of life care and dignity. The patients (and their families) showed such gratitude that we cared to insure their humanity, even when their medical condition was trying to rob them of that same humanity. We had to deliver the news of undesirable diagnoses. We saw the ravages of severe dpression, and learned how our caring and understanding allows the patient to start climbing out of the abyss. And we were fortunate enough to deliver some good news. This art of medicine makes our profession special.

The politicians will never understand. The insurers look at our patients as numbers not humans. The lawyers see the unfortunate as opportunities to sue (and gain contingency fees). But I see patients and want to help them. Sometimes my knowledge of science can make a dramatic difference. Sometimes I can use technology to make a diagnosis and get the right specialist to help the patient. But regardless, I can help the patient by bringing my humanity to the bedside and respecting the patient's humanity at all times. I really love my profession and feel fortunate that I found this way those many years ago.