Archive for May 22nd, 2011

The art of medicine

What do we mean when we invoke the subtle and ever so nebulous “art of medicine”?

Most people consider it an essential skill and part of being a good doctor to be able to correctly apply the art of medicine in the appropriate situation.

When we invoke the art of medicine with either patients or colleagues I think it can mean one of the following:

  • we’re about to do something that the doc who sent them in; the guidelines; the evidence; the protocols, would tell us not to do
  • the evidence tells us to do two different and mutually exclusive things
  • there is no evidence to what we’re about to do
  • we don’t know what’s wrong with the patient and we’ve just made up a diagnosis
  • we’ve got bored and done this

Calling it art is perhaps appropriating more value from the word “art” than is justified. But calling it bullshit wouldn’t go down to well either.

Perhaps for emergency docs it’s more like what Jerry Hoffman means in this talk┬áthat the art in medicine (my term not his) is our ability to make decisions in the absence of information.

The willingness to make and act on decisions made in the absence of adequate information requires a certain mixture of 2 things. One perhaps more valuable than the other

  • character; in the big muscular, practised Aristotelian sense
  • balls like a bull on steroids; though I find it odd that making a call as an act of bravado can be considered a positive trait
I confess that in any given moment I’m not entirely sure which of the two facets is at work in any resus room decision I make.
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