farmdoc's blog post number 111

Art and science. The practice of medicine includes both, but the mix is changing. Since I began studying medicine 45 years ago, the proportion of science has been increasing and, commensurately, art decreasing. A prime cause of this increasing science is advancing technology, and adjunctively the emergence of evidence-based medicine [EBM] which is of course the bean-counters’ nirvana. I’m sceptical about the utility of EBM medicine in the consulting room, because each patient is unique, and so data obtained from a group may not apply to an individual. A letter in the 28 July 2008 British Medical Journal said: ‘…modern medicine will fail to confront therapeutic uncertainties unless its practitioners offer their patients what they need most as human beings in distress: time, empathy, and understanding…(and)…a successful medical man has to exhibit supreme confidence and decisiveness at the patient’s bedside, whereas a doctor-scientist (trying to confront uncertainties) is likely to present a picture of diffidence and self doubt…the processes that work for one are devastating for the other’. Of course the ideal practitioner is knowledgeable and skilled in both the art and the science. But such people are rare. Me? I’m content to remain well back from the cutting edge of the science and EBM; and if that means enriching my work with the art of medicine, then I’ll consider that a badge of honour.