The art and science of medicine

Ars longa, vita brevisOne of my posts was featured today on KevinMD, Are physicians today active in the arts?.

While browsing the KevinMD site, I came across a post by “A Country Doctor,” Evidence based medicine at the expense of the art of medicine. My post was on the tradition of doctors as ”humanists” – educated professionals who contribute to the “fine” arts as writers, visual artists, and musicians. There’s a connection, however, between that tradition and the “art” of medicine.

What happens to doctors when the latest scientific methods of clinical decision making — as well as a reimbursement system that determines how medicine is practiced — encourage doctors to be little more than scientific technicians? Will their insight into the humanity and individuality of patients suffer? What happens to the physician’s art of addressing the uniqueness of each patient’s illness?

This issue comes up when discussing evidence-based medicine (EBM). Country Doctor points out that EBM emphasizes science to the detriment of art.

The proponents of uniformity … [fail] to understand the art in what we do. Health care is like food, wine or music. The ingredients, even the recipes, may look similar, but the interpretation and delivery makes it what it is. Two different doctors can deliver the same care in theory but get different clinical results and different patient satisfaction. And two patients with the same stage of a disease may respond differently to the same treatment. … Physicians need to take pride in their work and act like doctors, not health care drones, who blindly and mindlessly toil for the big health care machine. …

Even the New England Journal of Medicine recently printed an article that suggested that computers could make unnecessary the “master diagnosticians of past eras.”

Is it any wonder that so many hard-working, decent doctors are dissatisfied with their careers? Is it any wonder that the primary care specialties are having recruitment problems?

In the comments section for this post, a medical student confirms the trend towards an emphasis on the science rather than the art of diagnosis.

I’m a third year medical student, and I can’t tell you how hard they try to push Evidence-Based Medicine at us in school. It is not that I am against medicine practiced based on evidence, but the concept of using data from other patients (that are not our patient, and may not even be similar to our patient) to guide our decisions only brings an inappropriate uniformity and standardization to the practice of medicine.

Ars longa, vita brevis

In 1806, Thomas Jefferson wrote to Edward Jenner, congratulating him on the success of his smallpox vaccine. In his praise, Jefferson compares Jenner’s accomplishment to William Harvey’s discovery of the circulation of the blood (1628):

Harvey’s discovery of the circulation of the blood was a beautiful addition to our knowledge of the animal economy, but on a review of the practice of medicine before and since that epoch, I do not see any great amelioration which has been derived from that discovery.

The science of medicine has indeed come a long way since Jefferson’s time.

The art remains, however. As the father of Western medicine put it in an aphorism addressed to medical doctors: Life is short, the art is long, the occasion fleeting, and judgment difficult. By “art,” Hippocrates was referring to the years of training and patient observation that a physician must invest before acquiring the necessary skills of medicine.

A more nuanced translation of Hippocrates’ original Greek text might read: Life is too short; the task is huge; the right time is like a razor blade; the road to experience is fraught with hazards; to continuously accept reality and critical thought over hope and prejudice is taxing.

2400 years later, it’s an observation that still rings true for the medical profession.

Related posts:
The physician as humanist
Physician as lone practitioner
The doctor/patient relationship: What have we lost?
Universal health care: What would Socrates do?

Resources:

Image source: The Tile Design Company

Roy Porter and W.F. Bynum, The Art and Science of Medicine, Companion Encyclopedia of the History of Medicine, 1993

Ars longa, vita brevis, Wikipedia, last update September 3, 2010

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6 Responses to The art and science of medicine

  1. I came across your piece on physician writers on KevinMD. And then scanned your blog. Congratulations on inspiring work. It’s amazing how many fine blogs there are — and how little time to peruse them. There’s a new book which I have only dipped into — It’s called, “Wrong: Why the experts keep failing us” and a lot of it has to do with medicine. So much of what is in our journals is just wrong, or unexceptional — that’s why great art is so important. It is True — and only the true survives — Homer, Dante, Shakespeare, Eliot… do we waste our time with so many contemporary writers and composers? Osler spoke about the Academy of the Immortals, and the few doctors who were members (Keats, Goldsmith, Burton). How much of what we do as doctors is really “true?” And how much is based on false premises, marketing by PhRMA — promotion by paid expert KOLs? Keep fighting the good fight! DJE

    • I soo appreciate this kind of honesty, and the book recommendation. I think, like Jan, I will check into it.

      I tried to find a way to thank Jan privately at Kevin’s site, but I seem cyber-blinded……I enjoyed reading the feedback at Kevin’s on Jan’s article. Dr. S is the best..if I lived closer to him he would be our first choice as a physician.

      One wonders about the arts…..and as it was mentioned what is true…with all the constant need for instantaneous interaction via games and texts I am thinking doctors who are reluctant to e-mail are in for quite a shock…they may need to learn how to send video texts, or gravatars with messages. Art will be redefined, and some forms may become extinct.

      Anyhoo……just wrote to encourage you that I enjoyed your article.

  2. Thank you for your comment, Dr. Elpern. You’re so right about the number of blogs worth reading and how little time there is.

    I hadn’t come across the book “Wrong,” so I appreciate your pointing it out. I can see from the reviews on Amazon that it’s right up my alley. Life is so much more complicated than it was 100 years ago and we depend on experts. But individuals have motivations – conscious or not – to present interpretations of the “facts” that support biased interests.

    I’m reading “Merchants of Doubt” at the moment, which is about “doubt-is-our-product” challenges to scientific information. It’s not just about climate change, but cigarette smoking, second-hand smoke, nuclear winter, acid rain, DDT, and questioning the very value and validity of science. The amazing thing is that the same group of scientists is involved in opposing all these issues. The book is extremely well written.

    I was a beneficiary of the post-Sputnik emphasis on science and the National Defense Education Act. It had a huge impact on my life in that it allowed me to get an excellent education. So I appreciate the classics, but I also value contemporary authors. While their works may not survive as “True,” they stimulate thoughtful discussion and insight into the present and future. (I just read the novel “Super Sad True Love Story,” a chillingly realistic portrayal of how unpleasant the near future could be.)

    Pharma, KOLs, … don’t get me started. I just read Carl Elliott’s Mother Jones article on the suicide of young man in a trial for Seroquel. “Pharmaceutical companies are designing, analyzing, and publishing trials primarily as a way of positioning their drugs in the marketplace,” not to produce scientific knowledge. So many causes worthy of outrage. So much to read. So much to write about.

    Thanks again for writing.

  3. Thanks for coming here and reading, Alice, and thanks so much for the encouragement. I think we would all prefer that our physicians have the humanity and priorities of Dr. S, if only we had that option!

  4. “Will their insight into the humanity and individuality of patients suffer?”

    Yes. It is kuje beinbg on an assembly line when I go to the doctor’s office. They schedule 4-5 patients per hour; 10-15 minutes with each patient on the schedule. Patients today are simply $$$$$$.

    “What happens to the physician’s art of addressing the uniqueness of each patient’s illness?”

    It’s a goner. DOA

  5. Roberta – And most doctors – at least those on the front line in primary care – are as unhappy with the way things are as the patients. This isn’t what they signed up for.