Our Discipline Has Become as Much a Science as an Art å’å’ã¨â¨â³
Mens Sana Monogr. 2006 January-December; iv(1): 127–138.
Medicine: Science or Art?
S.C. Panda
* Banana Professor, Section of Community Medicine, V.Southward.South. Medical Higher, Burla, Orissa. Likewise, Editor, Periodical of Community Medicine. Email: Email: ni.oc.oohay@ssvmcuhdas
Received 2006 Mar 12; Revised 2006 Jul 7; Accepted 2006 Jul 10.
Abstract
Debate over the condition of medicine as an Art or Science continues. The aim of this paper is to discuss the meaning of Art and Science in terms of medicine, and to discover 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 grade of time, which has made present twenty-four hours medicine more sophisticated). What is also analysed is whether the "scientific discipline of medicine" is a pure one, or merely applied science; or the element of scientific discipline in information technology is full of uncertainty, simply considering what is accepted equally "scientific" today is discarded by medical practitioners tomorrow in the light of newer evidence. The paper also briefly touches upon how, in the field of nowadays medical education, the introduction of medical humanities or humanistic instruction has the potential to swing the pendulum of medicine more towards the lost "art of medicine".
The newspaper concludes by proverb that the fine art and science of medicine are complementary. For successful practice, a doctor has to be an artist armed with basic scientific knowledge in medicine.
Keywords: Art of Medicine, Science, Bear witness-based Medicine, Human Faculty, Humanistic Education
Introduction
Medicine is what helps or heals. From time immemorial, homo has been struggling to control disease. Medicine has advanced with the progress of science. It is thus congenital on the best of the past. Park (2002), discussing Medicine in Antiquity has rightly quoted Dubos:
Ancient medicine was the female parent of scientific discipline and played a large role in the integration of early culture.
Ancient medicine across the globe was different due to bright cultures and civilizations. In due course, this was enriched past integration of cultures beyond many geographical boundaries, races and ethnic groups. Due to this, medicine has undergone wide changes, so much then that its definition itself has metamorphosed many times.
What, then, is medicine? Many people call back it is a science, others think it is an fine art. Another group is of the view that medicine is both an fine art and a scientific discipline. Rogers (2006), in his Introduction to the Study of Medicine, says:
Medicine is sometimes considered a scientific discipline, and sometimes an fine art; the object of medical science is to study disease.
Steve Solomon has tried to define medicine in the first chapter of hygiene library itemize of his website. In his give-and-take he differs from the view of Rogers quoted above. According to Solomon (2006):
Man should exist studied in life and health-the influences on the body of food, habiliment, bathing, and the daily care of the trunk. A alive 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 exist a scientific study and its practice an art. The study of affliction requires the aid of science. Complete fine art is required to issue a cure when nature is no longer able to help herself.
I take tried to take steps hither 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 fine art of teaching philosophy, he said sometimes people opined that educational activity philosophy was an fine art. In order to explain it, he gave an example of distinguishing the art of medicine from its science cited commonly by people: "Sometimes people say, ′The practise of medicine is an art, non a scientific discipline′, or, ′The practice of medicine is an art, not an exact science′." He went alee past proverb that an Art involved "a skill acquired by experience" or observation.
That is applicable as much to the teaching of philosophy, as to the practice of medicine.
Saunders (2000) quotes Thomas Huxley in his paper thus:
Engineering is zero only 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. Withal the idea of the practise of clinical medicine every bit an fine art persists.
What exactly, and so, is the art of medicine? Hegde (1999) speaks of medicine as an art based on scientific discipline. The fine art of medicine remains the same and is the potent foundation of exercise. It is permanent and has evolved through the centuries based on human values and intuition. Its thrust is to allay anxiety in the minds of patients and to panel them under all circumstances. He describes farther:
Some years ago, survey done in Thailand showed that all kinds of doctors ranging from the quacks to the best trained modern practitioners have been equally effective in social club if they had human qualities of head and eye required to encourage the patients′ own healing power.
As per my observation, fifty-fifty in the villages, quacks, without any scientific training, provide intendance to the needy. Still people accept them; they are available and kind to the ill. According to Cecil'due south Textbook of Medicine (Goldman and Dennis, 2004), the art of caring and condolement, guided past millennia of mutual sense besides as a more recent systematic arroyo to medical ethics, remains the cornerstone of medicine - without these humanistic qualities the application of modern scientific discipline of "medicine" is suboptimal, useless, even detrimental.
Is Medicine A Science?
Unlike physics or chemistry, medicine is not a pure scientific discipline. When we call it an technology, it implies merely principles of pure scientific discipline are applied in medicine. Fifty-fifty the results obtained from sophisticated tools may be different. One pathologist may opine about 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 non true for all times, unlike truths in the field of the art of medicine in science. Today'south truth may be tomorrow's folly. The half-life of truth in medicine is curt. There is a maxim (Lakshmipati, 2003):
One-half of what is true today volition be proven to be wrong in the next five years. Unfortunately we don't know which half that is going to exist.
A modest example can be discussed here: the formulation of oral rehydration salts. WHO (2002) adopted the new ORS (low sodium, low glucose) formula to fight diarrhoea among under v children. This alter became necessary afterward studies conducted in v developing countries. Similarly, with surgical procedures. Many of them become outdated and surgeons prefer newer procedures to care for diverse problems. For example, the concept of a ripe cataract is outdated. Today, ophthalmologists opine that cataracts should exist removed when they cause symptoms by dissolving and removing the cataractous lens with ultrasound (often referred to as phacoemulsification). A clear, synthetic lens is then put in identify (Cataract FAQS, 2006). The surgical procedure called Thiersh operation in treating prolapsed rectum has get obsolete. Delorme's functioning is now the preferred operation (William Norman, 2004).
Management of diseases, even diagnostic methods and ideas on causation of a particular affliction, also change with passage of time.
Art Of Medicine?
Warsop (2002) asks in his article, "Is in that location anything intrinsic to medical practice that can reasonably exist called an art?" According to Saunders (2000), the fine art is not merely part of the "medical humanities" but is integral to medicine as an applied science, which requires what he calls a "doctrine of standard empiricism". This is described as a mode 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 not scientific, are essential to the practise of medicine every bit a science. These sorts of activities, constructed with evidence-based medicine, collectively constitute the 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 art of tending to the sick is as old as humanity itself. Compared with its long and more often than not distinguished history of caring and comforting, the scientific basis of medicine is remarkably contempo. Further the doc is advised to understand the patient as a person. Iii fundamental principles are important to practitioners. They are primacy of patient welfare, patient autonomy and social justice.
The kickoff principle lays accent on the patient. Patient'southward interest, business organization 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 decision near 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 of import considering the dr. is responsible for the individual patient and to the lodge at large. He should ensure that health intendance and health services are equally attainable and available to people of all strata of society.
In Cecil'due south Textbook of Medicine (Goldman and Dennis, 2004), fine art of medicine is conceived of as the action of patient advocacy by means of human faculty, and the part of scientific discipline as subordinate to the humane fine art of listening and advocacy is highlighted. Another view is that the goal of medicine is to produce healing or health for the sake of the patient, and not for the sake of art (Goldman and Dennis, 2004), whereas Saunders (2000) sees the art of medicine as part of the culture of science. Warsop (2002) says:
The corrective surgeon takes aesthetic factors into consideration every bit function of her daily work, but such factors are subsumed by the priority to restore her patient's wellness.
Warsop means to say that cosmetic surgeon's goal is not to create fine art, using her patient as raw material, as a potter uses clay. Citing this example, he concludes that medicine fails to authorize equally an art in the sense of art understood as fine art, every bit say painting or sculpture.
Art Versus Science
On many occasions doctors are criticized, abused and manhandled not 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 ill private. Mahajan (2006) cautions the physician not to allow scientific medicine to blunt his humanity, ignore ethics and the need for empathy. Hegde (1999) is of the view that doctors of all hues and colours have succeeded in practice mainly because they evidence concern for their patients and get beneficient towards them.
The art of medicine deals with the whole gamut of medico-patient relationship. Most patients recall that loftier-tech medicine tin practice wonders for suffering humanity. While it tin can do a lot in special situations like emergency care, in all other areas, the art of medicine rules the roost. Even in an emergency, human compassion can do a lot to assistance the protean machines, which can appear quite frightening to the critically ill. In the outdoor, indoor, operation theatre, labour room, during various investigations or in whatsoever survey of the community, everywhere, the doctor-patient relationship requires compassion, a caring attitude from the doctors, besides communication skills (Hegde, 1999). A surgeon, physician or any wellness intendance provider, needs to exist substantially a skillful human being. A knife merely cuts or a drug assists, along with the availability of best possible technology, drugs and other logistics. The vital forces of the body and the intense desire to live, or the positive attitude of the patient, are what really count. As well, other major factors such as concern, sympathy, pity, assurance and other humane qualities of the doctor, which can be termed the art of medicine, are of much importance in practicing medicine. Diagnosing disease and choosing the best treatment certainly requires scientific knowledge and technical skills in health intendance professionals. But just this much won't practise. Achtenberg (1996) said:
A medicine that cares or cures, helps or heals has an even greater consequence for humanity than that of merely mending, tending, patching or preventing the various ailments that are the result of being alive.
Practicing the art of medicine ane can mend the aches and pains of fellow human being beings. The act of giving service with a humane bear on - in the class of medicine, is the purest gesture of peace and communication; or nosotros tin can say, manifestation of medicine in an art class (Achtenberg, 1996)
Medicine Is Both Fine art And Science
And then far nosotros accept discussed art of medicine as a human being faculty that has to be based on science. Medicine, withal, is non an exact science. It is an practical science, and its practice is an art.
Then what exactly is medicine? In effective medicine, the ability imbued in the caregiver is based on trust, which may itself be integrated with the healing process. If people have trust and confidence in their provider, they follow their recommendations. If trust is absent they won't. Trust blossoms not simply out of competency or skill; information technology involves sensitivity to some other 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 ′show-based medicine. However, the view of science implied is a narrow one, strange both to pure scientists and to artists and the fine art of medicine is devalued by this arroyo. There are both important differences and important similarities between science and the arts. The arts should contribute to evidence-based practice and education along with scientific discipline, and have a office in many aspects of medical practice.
Saunders (2000) says, "The practise of clinical medicine with its daily judgments is both science and art. In the practice of clinical medicine, the art is not merely role of the ′medical humanities′ but is integrated to medicine as an applied science". Warsop (2002) finally agrees past saying that scientific discipline is of course essential to medicine, but medicine cannot be simply identified with pure science or even with applied science. The art of medicine is substantially equanimous of the clinical skills of listening and advocacy brought to bear in the consultation.
Tucker (1999) describes medicine as an art as well as a science. He says:
We all know this just over the ages this art/science ratio has undergone a dramatic alter. The medical pendulum is swinging from the art to the science side. All the same, in my opinion, the best clinician is i who armed with this scientific knowledge, practices using excellent clinical judgment (which of course is his art). Compassion and agreement are a large part of this fine art.
The art of medicine exists since the time of archaic medicine. Merely the science of medicine changes with the progress of science and changing concepts from fourth dimension to time. So, the art of medicine, or compassion, care, sympathy etc, are the building blocks of the practice of the science of medicine.
Revive The Dying Art Of Medicine
Trousseau (1869) says:
The worst man of science is he who is never an creative person, and the worst artist is he who is never a man of science. In early times, medicine was an fine art, which took its place at the side of poetry and painting; today they endeavor to make a scientific discipline of it, placing it abreast mathematics, astronomy, and physics.
He means to say that with progress of science and its application, there is a rapid pass up in the so-called human elements of health care providers, which dilutes the age-former dr.-patient relationship.
Philip Overby (2005) says:
Today, doctors are both more powerful and more deafened. They are far less helpless in the face of suffering, yet they often cannot hear the cries that evoke no possibility of remedy. A more humanistic educational activity might heal the physician'southward deafness. It will not make treating the untreatable any easier, only it may at least leave the physician less naked on the wards.
Hegde (1999) has also expressed like concern over the upshot. He says:
The fine art of clinical medicine is dying in the nowadays teaching set up up with high-tech gadgets. In the field of medical pedagogy these days, there is not much emphasis on the fine art of medicine. In only one university in the world, at Brisbane, students are recruited into medical schools after they have learnt music, philosophy etc, a very skilful beginning indeed.
Philip Overby (2005), in his paper, says:
Many writers take argued that art and literature should have a identify in the medical curriculum on the grounds that fine art helps doctors to understand experiences, affliction and human being values and that art itself can fulfill a therapeutic role. At its best humanistic education will assist 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 education is realized beyond the world and steps accept been taken to innovate information technology in various medical schools and universities (Evans and Greaves, 2001; Glasser, 2001; Meakin, 2002).
Conclusion
Medicine is both an fine art and a science. Both are interdependent and inseparable, just similar 2 sides of a money. The importance of the art of medicine is because we have to deal with a human being, his or her body, mind and soul. To exist a good medical practitioner, one has to get a good artist with sufficient scientific noesis. Engineering science covered with the layer of art alone tin bring relief to the sick.
In the field of medical education, this dying art of medicine has to exist revived throughout the globe. And so the determination to the fence on the condition of medicine as art or science is crystal clear. Let the states conclude with the famous words of Albert Einstein (Wikiquote, 2006):
The most beautiful thing nosotros can feel is the mysterious. Information technology is the source of all true fine art and all scientific discipline. He to whom his emotion is a stranger, who can no longer suspension to wonder and stand rapt in awe, is equally expert as dead; his eyes are closed.
Questions That This Newspaper Raises
-
How to revive the dying fine art of medicine in this hi-tech age?
-
How do nosotros find out ways and means to integrate the "art of medicine" with the "scientific discipline of medicine"?
-
What is the nowadays state of medical education in terms of "art of medicine"?
-
What is the role of art of medicine in achieving "wellness for all" across the globe?
-
Is there a need for change in the medical curriculum so equally to produce doctors who will be able to practice medicine to serve humanity with humanistic qualities based on scientific knowledge?
Most the Writer
Sadhu Charan Panda (M.D.) is Editor, Journal of Community Medicine (ISSN 0973-2454). He is likewise Banana Professor (Senior Teacher), V.S.S. Medical College, Burla -768017 (Orissa). He was Assistant Surgeon under Orissa Wellness 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 country and national journals, and had fabricated presentations at various conferences. He has participated in workshops and grooming programmes in NTI, NICD, Govt. Medical College, Surat, B.H.U. etc. He is a Life member: IPHA, IAPSM, IMA. He is also Member, WAME and Rotary (PHF).
Footnotes
Citation: Panda S.C. (2006), Medicine: Scientific discipline Or Art? In : What Medicine Ways To Me (Ajai R. Singh, Shakuntala A. Singh Eds.), MSM, III:6, Iv:1-iv, p127-138.
Disharmonize of Interest: None declared.
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 as learned and humane profession. (22nd ed) 2004;ane:1–2. Saunders. [Google Scholar]
8. Lakshmipati G. Care of the medical outpatient, (Preface) 1st ed. 2003. pp. 7–vii. Nama publication, Coimbatore, Tamilnadu.
12. Park Yard. From Park'due south Textbook of Preventive and Social medicine. 17th ed. 2002. Human being and medicine: towards wellness for all; p. 01. Banarasidas Bhanot, Jabalpur, Republic of india. [Google Scholar]
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Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3190445/
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