We do practice in that we are always reading and learning; trying to be more proficient at and knowledgeable about what we do. Most of all, through various experiences and outcomes, and not so much trial and error, we come to see what works and what doesn't work.
But somehow these activities do not seem to capture all that the phrase "practice of medicine" represents. It cannot simply be that "practice" emphasizes being engaged in a profession, since outside of medicine, nursing, and law, we rarely hear the phrase applied to other professions.
The ancient philosophers reserved the phrase "in the practice of" for those who provided special service to others. "In nothing do men more nearly approach the gods than in [the practice of] health to men." (Cicero) At the turn of the last century, Sir Henry Osler, the Canadian physician who wrote eloquently about medicine, spoke of the practice of medicine being "an art, not a trade; a calling, not a business; a calling in which your heart will be exercised equally with your head." Eugene Stead was chairman of the department of medicine at Duke University for many years and one of the legends of American medicine and medical teaching. As interns and residents, almost daily we would hear one of his aphorisms. One that I heard early in my internship was that "the care of the patient should be carried out by doctors who are interested in giving service to people."
After 10 years in practice, I think about what I have learned outside of books or teaching rounds. First, internship and residency do not fully prepare you for the practice of medicine. Our training is generally a series of brief encounters with a premium placed on swift and accurate diagnosis, treatment and disposition. Practice, on the other hand, particularly when caring for sick patients with kidney disease, is about longer associations that emphasize improving a patient's quality of life.
Second, I have learned we have little control over our day. This was not fully expected when I went into practice. As a post-graduate fellow in research, my days, no less long than they are now, had been more predictable. But in practice, schedules are quickly disrupted. There are endless phone calls to answer and reports to review. Simple and routine procedures become time consuming. A patient's condition deteriorates to life-threatening. But diseases are not rational and, therefore, we should not expect our patients or schedules to be rational.