Art Vs. Science

‘The practice of medicine in its broadest sense includes the whole relationship of the physician with his patient. It is an art, based to an increasing extent, on the medical sciences, but comprising much that still remains outside the realm of any science. The art of medicine and the science of medicine are not antagonistic but supplementary to each other. There is no more contradiction between the science of medicine and the art of medicine than between the art of flying & the science of aeronautics.’

 It is regrettable that the Doctor-patient relationship has eroded considerably today. A substantial proportion of patients believe that the doctors do not spend enough time, do not explain and are more interested in money.

This erosion of credibility, brought about by increasing commercialism and entrepreneurial activity reflects the failure of the doctor to balance the science and art of medicine.

The Art of Medicine

The Art of Medicine that the secret of good care of the patient is in caring for the patient. It entails the qualities of humanism, diligence, honesty, altruism and ethical behaviour.

Humanism is the attitude of giving primary importance to human interest, values and dignity, It is the skill required to handle demanding interpersonal situations involving patients and their families, the ability to be courteous to the patient and her family at all times, sensitivity to their need of information, contact and encouragement finally, respect for their privacy. They should also respect the patients’ choices regarding their care. Poverty, illiteracy and ignorance of the patient & family are not adequate reasons for the physician to make sole decisions. Physicians should encourage rather than discourage questions, answering them simply & clearly. They should be receptive to their patient’s views, however absurd they sound, and dispel their anxiety with explanations and, if necessary, gentle repeated reassurances.

Rather than abjectly obey orders patients should be encourage taking charge of their health under the doctor’s guidance. To this end the physician should constantly try to remain approachable and not seem distant and forbidding. Care must be taken not to destroy the hope within the patient. It is also a worthwhile practice to have the patient repeat the doctor’s instructions to make sure that he has fully understood them. The physician must also recognise the importance of nonverbal skills in communication. Facial expression and the degree of animation in conversation may indicate tot eh patient how involved the physician is. Physicians must not forget the importance of simple gestures such as sitting down while talking to the patient or a simple gentle touch that may serve to establish a care-giving bond.

Diligence and honesty demand a sense of commitment to one’s duty and putting nothing but the best that one has into the task of patient care.

 A certain amount of altruism defined as unselfish concern for a devotion to the welfare of others is an intrinsic part of medicine. A physician must place the welfare of the patient above his other social, financial, or academic self-interest.

Ethical behaviour requires that the doctor maintains confidentiality, obtains informed consent, retains accountability and respect for human rights in dealing with patients.

The Science of Medicine

            The Scientific Method applies to medicine as well. It involves the generation of a ‘tentative hypothesis’, ‘the setting up of an experiment’ and the analysis of results obtained from the experiment to see whether the hypothesis is supported or refuted. Clinical Medicine involves the use of observational skills to obtain information regarding the patients’ disease. The information obtained from several sources (history, examination, laboratory) is organised and synthesised to yield a set of diagnostic possibilities  (Differential diagnosis). Clinical skills are then used again in selecting the ‘tentative diagnosis’ and making further tests to support or refute the same. If diagnosis is refuted another one is tested – a clinical procedure known as iterative hypothesis testing. If the diagnosis is established, clinical judgement is used to decide what form of management is of greatest benefit to the patient at the least risk and cost.

            The process of clinical information collection must also bear scientific scrutiny. The physician must be aware of the accuracy, precision, variance, validity, sensitivity and specificity of the information in order to be truly scientific.

            Accuracy means how closely eh given information reflect the true state.

            Precision refers to the reproducibility of a piece of clinical information as measure by the variability in the results in the observation is repeated. Clearly information, which is precise, need not be accurate.         

Variability in the observations may occur when the same person repeat (Intraobeserver variance)

or when another repeats (Interobserver Variance).

            The presence or absence of certain clinical findings leads the clinician to draw certain interferences regarding the condition patient. The sensitivity of a test is its ability to detect true positives. The specificity of a test helps us to know whether the disease can be excluded if the test were negative, that is, the ability to detect true negatives. Two other terms the physician must be aware are the positive predicative value and negative predicative value of a test. The former tells about the probability of the disease in a patient with a positive test. The physician must realise that a test (with a given sensitivity and specificity) may have a variable predicative value in different value in different groups of patients depending on the prevalence of disease in the given groups. (This idea is quantifies as ‘Bayes Theorem’ which states the post hoc probability of a given disease depends on the pretest probability of having the disease.)