Saturday, February 4, 2012

The Art and Science of Medicine. Ya Gotta Have Heart!

It was the beginning of the academic year in 2011 here in New Jersey. The first year medical students sat with enthusiasm and anticipation listening to the lecturer.  Each student came to learn medicine and eventually choose a specialty practice. Each student had passed a rigorous battery of tests and interviews to become accepted to medical school.  Their extensive academic journey began.

One of the opportunities I enjoy most is to offer lectures and short workshops for medical students and physicians. While the medical school and all of the clinical work fills them with tremendous knowledge about the science of medicine not every one is afforded the opportunity to learn the art of medicine. I am heartened to know this tide is turning.

Before what we now call modern medicine was practiced doctors, healers, etc. used what they had at hand to help the symptoms of illness or pain.  Before antibiotics were commonplace infection often was the cause of death rather than the injury or illness itself. So many works of art portray the doctor sitting by the patient’s bedside. The doctor was summoned to CARE for the patient. The community healer came with their limited poultices, balms and tinctures. In the end they sat at the bedside and attended the person’s death. Before they left the home they comforted the family the best they could.  When the medicine could not heal, the healer became the medicine caring for the patient and family.

I’d like to define the terms of science and art from my perspective.

The science of medicine is FACT based. Much like mathematics the science is either proven or unproven. It is reproducible fact. Clinical trials as an example prove that a new chemotherapy, for instance, has efficacy or not before it becomes an acceptable practice for use. I see doctors learn the science of medicine much like mathematical formulas. If X is true than Y+Z= R.

The art of medicine looks at the same formula. If X is true than Y+Z= R.  However, what happens when X is true and Y+Z= R. but no R can be found? The questions then begin. Why no R? Is there a new formula possible that we didn’t know before? What other factors other than X, Y, & Z did we not consider? What else is involved or missing? What’s their instinct pushing them towards considering? Their training informs “the gut” while searching.

The art of medicine is also the acknowledgement of humanity and the complex emotions of living, limitation and illness.  It also is the journeying in life with a person as they move closer to their end and eventual death.

I once heard someone say the two greatest fears of a patient are intractable pain and abandonment by their doctor if there isn’t any cure.  Pain is controllable now with a myriad of medications, combinations and delivery systems.

For a patient to trust that regardless of outcome, the physician truly cares and will journey with them until there no longer is life to me is the epitome of the healing art of medicine. The physician’s presence alone may become the healing that brought them to the practice of medicine.

The new classes of doctors who are graduating are being asked to never forget listen to their patient’s life narrative as they apply the science of medicine. Someday these doctors will be at my bedside and I am grateful the old/new art is flourishing.

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