Amaã¢âåto Promote the Art and Science of Medicine and the Betterment of Public Healthã¢ââ
Mens Sana Monogr. 2006 Jan-Dec; 4(1): 127–138.
Medicine: Science or Fine art?
S.C. Panda
* Assistant Professor, Department of Community Medicine, V.S.S. Medical College, Burla, Orissa. As well, Editor, Journal of Community Medicine. Electronic mail: Email: ni.oc.oohay@ssvmcuhdas
Received 2006 Mar 12; Revised 2006 Jul 7; Accepted 2006 Jul 10.
Abstract
Debate over the status of medicine as an Fine art or Science continues. The aim of this newspaper is to talk over the meaning of Fine art and Science in terms of medicine, and to find out to what extent they have their roots in the field of medical practice. What is analysed is whether medicine is an "art based on scientific discipline"; or, the "art of medicine" has lost its sheen (what with the rapid advancements of science in form of fourth dimension, which has made present twenty-four hours medicine more sophisticated). What is also analysed is whether the "scientific discipline of medicine" is a pure ane, or merely engineering science; or the element of scientific discipline in it is full of uncertainty, simply because what is accepted as "scientific" today is discarded past medical practitioners tomorrow in the calorie-free of newer testify. The paper besides briefly touches upon how, in the field of present medical education, the introduction of medical humanities or humanistic didactics has the potential to swing the pendulum of medicine more than towards the lost "art of medicine".
The newspaper concludes by saying that the fine art and science of medicine are complementary. For successful do, a doctor has to exist an artist armed with basic scientific knowledge in medicine.
Keywords: Art of Medicine, Science, Evidence-based Medicine, Man Kinesthesia, Humanistic Education
Introduction
Medicine is what helps or heals. From time immemorial, man has been struggling to control disease. Medicine has advanced with the progress of science. It is thus built on the best of the past. Park (2002), discussing Medicine in Antiquity has rightly quoted Dubos:
Ancient medicine was the female parent of science and played a large part in the integration of early civilisation.
Ancient medicine across the globe was different due to vivid cultures and civilizations. In due course, this was enriched by integration of cultures across many geographical boundaries, races and indigenous groups. Due to this, medicine has undergone wide changes, then much so that its definition itself has metamorphosed many times.
What, then, is medicine? Many people think it is a science, others call up it is an art. Another group is of the view that medicine is both an art and a science. Rogers (2006), in his Introduction to the Study of Medicine, says:
Medicine is sometimes considered a science, and sometimes an art; the object of medical science is to study disease.
Steve Solomon has tried to define medicine in the first chapter of hygiene library catalog of his website. In his discussion he differs from the view of Rogers quoted higher up. According to Solomon (2006):
Man should exist studied in life and wellness-the influences on the trunk of food, clothing, bathing, and the daily care of the body. A live man, well understood, is worth more from a health standpoint than thousands of dead men. The aim of medical art is to restore and maintain health.
He further points out:
Medicine is supposed to be a scientific study and its exercise an art. The study of illness requires the assist of science. Consummate art is required to effect a cure when nature is no longer able to assistance herself.
I accept tried to take steps here to unfold the mystery over the status of medicine by an in-depth analysis.
Is Medicine An Fine art?
When Decyk (1996) was delivering his presidential address in Leonardo'south workshop on The art of pedagogy philosophy, he said sometimes people opined that educational activity philosophy was an art. In lodge to explain it, he gave an case of distinguishing the art of medicine from its science cited ordinarily by people: "Sometimes people say, ′The practice of medicine is an fine art, not a science′, or, ′The do of medicine is an art, not an exact science′." He went alee by saying that an Art involved "a skill acquired past experience" or observation.
That is applicative as much to the teaching of philosophy, every bit to the practice of medicine.
Saunders (2000) quotes Thomas Huxley in his paper thus:
Technology is goose egg but the application of pure science to particular classes of problems. No 1 can safely make these deductions unless he or she has a firm grasp of the principles. All the same the thought of the practise of clinical medicine as an art persists.
What exactly, then, is the art of medicine? Hegde (1999) speaks of medicine as an fine art based on science. The art of medicine remains the aforementioned and is the strong foundation of practice. It is permanent and has evolved through the centuries based on homo values and intuition. Its thrust is to allay anxiety in the minds of patients and to console them under all circumstances. He describes farther:
Some years ago, survey washed in Thailand showed that all kinds of doctors ranging from the quacks to the all-time trained modern practitioners take been as constructive in society if they had human qualities of caput and heart required to encourage the patients′ own healing power.
As per my observation, even in the villages, quacks, without any scientific training, provide intendance to the needy. Still people take them; they are available and kind to the sick. According to Cecil'southward Textbook of Medicine (Goldman and Dennis, 2004), the art of caring and comfort, guided by millennia of common sense as well as a more than recent systematic approach to medical ethics, remains the cornerstone of medicine - without these humanistic qualities the awarding of modernistic science of "medicine" is suboptimal, useless, fifty-fifty detrimental.
Is Medicine A Science?
Unlike physics or chemistry, medicine is not a pure science. When we phone call it an engineering, information technology implies only principles of pure science are applied in medicine. Even the results obtained from sophisticated tools may be different. One pathologist may opine near a particular case as malignant, which may not be corroborated if some other colleague examines information technology. Hegde (1999) has rightly mentioned that scientific truths are not true for all times, different truths in the field of the fine art of medicine in science. Today's truth may be tomorrow'due south folly. The one-half-life of truth in medicine is short. In that location is a proverb (Lakshmipati, 2003):
Half of what is truthful today will be proven to be incorrect in the next five years. Unfortunately we don't know which half that is going to exist.
A small case can exist discussed here: the formulation of oral rehydration salts. WHO (2002) adopted the new ORS (low sodium, low glucose) formula to fight diarrhoea among under five children. This change became necessary afterward studies conducted in 5 developing countries. Similarly, with surgical procedures. Many of them go outdated and surgeons prefer newer procedures to treat diverse problems. For case, the concept of a ripe cataract is outdated. Today, ophthalmologists opine that cataracts should be removed when they cause symptoms by dissolving and removing the cataractous lens with ultrasound (oft referred to as phacoemulsification). A clear, synthetic lens is and so put in place (Cataract FAQS, 2006). The surgical procedure called Thiersh operation in treating prolapsed rectum has become obsolete. Delorme'due south performance is now the preferred operation (William Norman, 2004).
Management of diseases, even diagnostic methods and ideas on causation of a particular disease, also modify with passage of time.
Art Of Medicine?
Warsop (2002) asks in his article, "Is there anything intrinsic to medical practice that can reasonably be called an art?" According to Saunders (2000), the art is non simply office of the "medical humanities" but is integral to medicine as an practical science, which requires what he calls a "doctrine of standard empiricism". This is described as a manner of enquiry the aim of which is to promote "objective knowledge and truth" and to provide explanations and understanding. Doctors undertake various kinds of activities, which, though non scientific, are essential to the practice of medicine every bit a science. These sorts of activities, constructed with evidence-based medicine, collectively constitute the fine art of medicine.
In Cecil's Textbook of Medicine (Goldman and Dennis, 2004), medicine is
…a profession that incorporates science and scientific methods with the art of being a physician. The fine art of disposed to the sick is as sometime equally humanity itself. Compared with its long and generally distinguished history of caring and comforting, the scientific basis of medicine is remarkably contempo. Farther the physician is advised to understand the patient equally a person. Iii fundamental principles are important to practitioners. They are primacy of patient welfare, patient autonomy and social justice.
The first principle lays accent on the patient. Patient's involvement, business concern or welfare comes kickoff. The plethora of diagnoses and treatment options are secondary and subsidiary to patient welfare. The second principle speaks of the final conclusion virtually his or her treatment option, which lies with the patient. A doctor only recommends. In the process of dealing with patients, social justice again is of utmost priority. It is important because the md is responsible for the individual patient and to the guild at large. He should ensure that health care and health services are equally accessible and available to people of all strata of society.
In Cecil's Textbook of Medicine (Goldman and Dennis, 2004), fine art of medicine is conceived of equally the activity of patient advancement by means of man kinesthesia, and the role of science as subordinate to the humane fine art of listening and advocacy is highlighted. Some other view is that the goal of medicine is to produce healing or health for the sake of the patient, and non for the sake of fine art (Goldman and Dennis, 2004), whereas Saunders (2000) sees the fine art of medicine as part of the culture of scientific discipline. Warsop (2002) says:
The cosmetic surgeon takes aesthetic factors into consideration as part of her daily work, but such factors are subsumed by the priority to restore her patient's health.
Warsop ways to say that cosmetic surgeon's goal is non to create art, using her patient as raw fabric, every bit a potter uses clay. Citing this example, he concludes that medicine fails to qualify as an art in the sense of fine art understood equally fine art, as say painting or sculpture.
Art Versus Science
On many occasions doctors are criticized, abused and manhandled non because of their paucity of noesis. Rather, information technology is related to their insensitive behaviour and for completely ignoring the emotional distress and strain affecting a sick private. Mahajan (2006) cautions the physician non to allow scientific medicine to edgeless his humanity, ignore ideals and the demand for empathy. Hegde (1999) is of the view that doctors of all hues and colours have succeeded in exercise mainly because they show concern for their patients and become beneficient towards them.
The art of medicine deals with the whole gamut of doc-patient relationship. Most patients recall that high-tech medicine can practise wonders for suffering humanity. While it can do a lot in special situations like emergency care, in all other areas, the fine art of medicine rules the roost. Even in an emergency, homo pity can do a lot to assist the protean machines, which tin appear quite frightening to the critically ill. In the outdoor, indoor, operation theatre, labour room, during various investigations or in any survey of the community, everywhere, the doctor-patient human relationship requires compassion, a caring attitude from the doctors, also advice skills (Hegde, 1999). A surgeon, dr. or whatever health care provider, needs to be substantially a good human existence. A knife just cuts or a drug assists, forth with the availability of all-time possible technology, drugs and other logistics. The vital forces of the body and the intense desire to alive, or the positive attitude of the patient, are what really count. Also, other major factors such as concern, sympathy, compassion, assurance and other humane qualities of the doctor, which tin can be termed the fine art of medicine, are of much importance in practicing medicine. Diagnosing disease and choosing the all-time treatment certainly requires scientific noesis and technical skills in wellness care professionals. Only simply this much won't do. Achtenberg (1996) said:
A medicine that cares or cures, helps or heals has an even greater event for humanity than that of simply mending, tending, patching or preventing the various ailments that are the result of being alive.
Practicing the art of medicine one can mend the aches and pains of swain human beings. The act of giving service with a humane touch - in the form of medicine, is the purest gesture of peace and advice; or we tin say, manifestation of medicine in an art form (Achtenberg, 1996)
Medicine Is Both Fine art And Scientific discipline
So far we have discussed art of medicine equally a human faculty that has to be based on scientific discipline. Medicine, however, is not an exact scientific discipline. Information technology is an applied science, and its practice is an fine art.
So what exactly is medicine? In effective medicine, the power imbued in the caregiver is based on trust, which may itself be integrated with the healing process. If people accept trust and conviction in their provider, they follow their recommendations. If trust is absent they won't. Trust blossoms not only out of competency or skill; it involves sensitivity to another world-view. Moreover, trust evolves out of the persona of the caregiver (Achtenberg, 1996). According to Smith and Taylor (1996):
That Medicine is a science is the popular conventionalities, and this has been reinforced by the advent of ′evidence-based medicine. However, the view of science unsaid is a narrow 1, foreign both to pure scientists and to artists and the fine art of medicine is devalued past this approach. There are both important differences and important similarities betwixt scientific discipline and the arts. The arts should contribute to evidence-based practice and education along with science, and have a part in many aspects of medical practice.
Saunders (2000) says, "The practice of clinical medicine with its daily judgments is both science and art. In the practice of clinical medicine, the art is not merely part of the ′medical humanities′ but is integrated to medicine as an engineering". Warsop (2002) finally agrees past saying that science is of course essential to medicine, but medicine cannot exist simply identified with pure science or fifty-fifty with engineering. The art of medicine is essentially composed of the clinical skills of listening and advancement brought to comport in the consultation.
Tucker (1999) describes medicine as an art too as a science. He says:
Nosotros all know this only over the ages this art/scientific discipline ratio has undergone a dramatic alter. The medical pendulum is swinging from the art to the scientific discipline side. However, in my opinion, the best clinician is i who armed with this scientific knowledge, practices using fantabulous clinical judgment (which of class is his art). Compassion and understanding are a large role of this fine art.
The art of medicine exists since the time of primitive medicine. Merely the scientific discipline of medicine changes with the progress of science and changing concepts from time to time. So, the fine art of medicine, or compassion, care, sympathy etc, are the building blocks of the exercise of the science of medicine.
Revive The Dying Fine art Of Medicine
Trousseau (1869) says:
The worst human of scientific discipline is he who is never an artist, and the worst artist is he who is never a man of scientific discipline. In early on times, medicine was an art, which took its place at the side of poetry and painting; today they try to brand a science of information technology, placing it beside mathematics, astronomy, and physics.
He means to say that with progress of science and its awarding, in that location is a rapid pass up in the then-chosen human elements of health care providers, which dilutes the age-sometime doctor-patient relationship.
Philip Overby (2005) says:
Today, doctors are both more powerful and more than deaf. They are far less helpless in the face of suffering, even so they oft cannot hear the cries that evoke no possibility of remedy. A more humanistic pedagogy might heal the md's deafness. Information technology will not make treating the untreatable any easier, only it may at least leave the physician less naked on the wards.
Hegde (1999) has as well expressed similar concern over the outcome. He says:
The art of clinical medicine is dying in the present pedagogy set up with loftier-tech gadgets. In the field of medical education these days, there is not much emphasis on the art of medicine. In only one university in the earth, at Brisbane, students are recruited into medical schools afterwards they have learnt music, philosophy etc, a very good beginning indeed.
Philip Overby (2005), in his paper, says:
Many writers have argued that art and literature should have a place in the medical curriculum on the grounds that fine art helps doctors to understand experiences, illness and human values and that art itself tin can fulfill a therapeutic role. At its best humanistic teaching will help doctors at the bedside by forcing them to grapple with the kinds of existential question that their patients can avoid.
The importance of medical humanities in medical instruction is realized across the world and steps have been taken to innovate it in various medical schools and universities (Evans and Greaves, 2001; Glasser, 2001; Meakin, 2002).
Decision
Medicine is both an art and a science. Both are interdependent and inseparable, just similar two sides of a coin. The importance of the art of medicine is because nosotros have to bargain with a human, his or her body, mind and soul. To be a good medical practitioner, one has to become a good artist with sufficient scientific knowledge. Engineering covered with the layer of art lone can bring relief to the ill.
In the field of medical didactics, this dying art of medicine has to be revived throughout the world. So the conclusion to the contend on the status of medicine every bit art or science is crystal clear. Let us conclude with the famous words of Albert Einstein (Wikiquote, 2006):
The most cute thing we can experience is the mysterious. It is the source of all truthful art and all science. He to whom his emotion is a stranger, who tin can no longer pause to wonder and stand up rapt in awe, is as expert as expressionless; his eyes are airtight.
Questions That This Newspaper Raises
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How to revive the dying fine art of medicine in this hi-tech age?
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How do nosotros discover out ways and means to integrate the "fine art of medicine" with the "science of medicine"?
-
What is the present state of medical education in terms of "art of medicine"?
-
What is the role of art of medicine in achieving "health for all" across the earth?
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Is there a need for change in the medical curriculum and so as to produce doctors who will be able to exercise medicine to serve humanity with humanistic qualities based on scientific knowledge?
About the Author
Sadhu Charan Panda (K.D.) is Editor, Journal of Community Medicine (ISSN 0973-2454). He is besides Assistant Professor (Senior Instructor), Five.South.S. Medical Higher, Burla -768017 (Orissa). He was Assistant Surgeon under Orissa Health Service from 17-01-1986 to 19-02-1997 and entered Orissa Medical Education Service from 20-02-1997 and continues till date. He has publications in state and national journals, and had made presentations at diverse conferences. He has participated in workshops and training programmes in NTI, NICD, Govt. Medical Higher, Surat, B.H.U. etc. He is a Life member: IPHA, IAPSM, IMA. He is too Member, WAME and Rotary (PHF).
Footnotes
CITATION: Panda S.C. (2006), Medicine: Scientific discipline Or Fine art? In : What Medicine Means To Me (Ajai R. Singh, Shakuntala A. Singh Eds.), MSM, Three:6, IV:one-four, p127-138.
Conflict of Interest: None alleged.
References
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6. Goldman L, Dennis A, editors. Cecil's Text Book of Medicine, Approach to medicine, the patient, and the medical profession: medicine every bit learned and humane profession. (22nd ed) 2004;1:1–2. Saunders. [Google Scholar]
viii. Lakshmipati 1000. Intendance of the medical outpatient, (Preface) 1st ed. 2003. pp. 7–vii. Nama publication, Coimbatore, Tamilnadu.
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Articles from Mens Sana Monographs are provided here courtesy of Wolters Kluwer -- Medknow Publications
Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3190445/