The art of medicine. Presence

Purpose. - The purpose of this article is to make the recent work by Arthur Kleinman, Professor of Psychiatry and Medical Anthropology at Harvard, better known in France. Method. - This article is a translation of an article published in the journal The Lancet in 2017. Arthur Kleinman, then just retired from his clinical practice, tells about his clinical experience of care and particularly about the importance of the notion of "presence" in care. Results. - He defines this notion from the acts constituting care itself, with reference to the fields of sociology, anthropology and artistic representation. He then contextualizes it in the professional and intimate spheres. He also defines this "presence" as having a function in self-care, impaired during pathological states like depression, and potentially positively implicated in the placebo effect, and also in the daily practice of professional caregivers as a protection against burn-out. Discussion. - How can care and this "presence" in care be reinstated in a context marked by economic and administrative imperatives and the ideology of evidence-based medicine? Conclusion. - The author proposes that the human qualities of medical and nursing students should be better supported and valued. He also suggests the need to work towards a better evaluation of the quality of care, which could in particular be based on ethnographic methods. He stresses the role that the medical profession has to play in defending what should be returned to the heart of its practice. (C) 2018 Elsevier Masson SAS. All rights reserved.