What happened to the art of medicine?

During our medical training we are taught to use evidence based medicine.  This means using the most up to date scientific research data that has been analyzed and accepted as fact.  But does this mean every patient we see fits into the evidence based medicine algorithm that we have been taught to use?

I hope not.  For this would mean we would only be following half of medicine.  The art of medicine is the other half, and is the most important.   The art of medicine can be defined as being how we apply evidence based medicine to each and every patient we see.  We are to use the evidence based algorithms solely as guidelines.  Each and every patient has to be treated as an individual.  As individuals they don’t all fit the evidence based medicine algorithms as perfectly as the guidelines require.

The art of medicine, the most important part of medicine, involves several components:

  1. Caring for patients, showing honest concern and compassion
  2. Giving patient’s time, not rushing in and out of the exam clinic room, being patient with them, having a great bedside manner
  3. Using the evidence based medicine algorithms as a guideline, as we apply them to each and every patient we see.  Understanding that every patient is an individual who has individual circumstances that affect their lives
  4. Helping every patient to acquire the best outcome they can for themselves by working with them, educating them, coming up with a mutually agreed upon plan of action

Evidence based medicine does not teach us how to apply them to the patients we see, only the art of medicine does that.  Much unlike evidence based medicine we don’t learn the art of medicine in a classroom.  We learn the art of medicine by seeing patients, one by one, year after year.  As new research comes out and the evidence based medicine algorithms change, hopefully we have refined our art of medicine skills to such a fine point that we have attained the stature of a wise mentor.

It is when we become this wise mentor who has been able to aptly combine the art of medicine with the research based evidence of medicine that we can parlay our skills to those of us who are younger, still in training and learning the skills of a medical provider.

I remember my training days and to this day I can still recall those wise mentors who played such an important role in my training.  As we teach those young, up and coming medical providers let us not forgot how to teach them to use and refine their own art of medicine.

Sharon Bahrych is a physician assistant who blogs at A PA View on Medicine.

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  • http://pulse.yahoo.com/_BEVHFIUYVNRNU6ZRTZBEV6BNEY Geri

    Thank you for articulating this so well!  EBM may provide guidelines, starting places …but cannot always inform/predict the most effective path for an individual patient…….hence the essential nature of the art.  

    Time magazine did a q&a with Dr. Oz that goes along with this too. What was the best advice someone gave you while you were in medical school? “Half of what we will teach you in medical school will, by the time you are done practicing, be proved wrong.”http://www.time.com/time/specials/packages/article/0,28804,1912201_1912244_1913478,00.html #ixzz1cdfVfU3U

  • http://www.facebook.com/people/Natalie-A-Sera/743004321 Natalie A. Sera

    There is the old medical axiom that, when you hear hoofbeats, think horses, not zebras. But the unfortunate fact remains that some of us ARE zebras, and it is easy to misdiagnose and mistreat us. Having had that experience, I am very dubious of EBM when it is uniformly applied to everyone without acknowledging that some facts about the patient may not fit the picture. There are always outliers in every bell-shaped curve study. Don’t assume that you’ve treated everyone when you treat the 90% — the other 10% deserve proper treatment, too.

    • Anonymous

      Natalie:  the point of my short blog above was to point out that EBM only goes so far.  We are to only use EBM as a guideline.  We are to NEVER use EBM alone.  NO patient fits the EBM algorithm perfectly, that is the reason that we need to ALWAYS incorporate the ‘art of medicine’ and use both EBM and the ‘art of medicine’ together in treating each and every patient.  You are correct in your understanding that 10% of patients fall outside of the normal bell curve and we need to always remember this.  I wish you the best. 

  • Anonymous

    I attended Baylor College of Medicine, but not as a med student, I went through their PA program.  The best medical sage advice I rec’d was from an opthalmologist who was getting ready to retire.  He told me ‘be sure of what you do know, and then what you don’t know, ask, ask, ask again until you get the answer that makes sense. Don’t ever be afraid to ask for help.’ 

  • Anonymous

    Excellent thoughts and I don’t think most clinicians or non-clinicians would disagree that Medicine is both Science and Art.  The art part relates to individual patient conditions, as well as a clinician’s intuition.  However, Evidence still needs to be prominent in helping to guide a clinicians decisions just so that it is not ONLY based on intuition or noise created by external sources that may have a bias.  Strength of evidence is important so unbiased sources of evidence compilation are important to combine with the Art of Medicine.

  • Anonymous

    What happened to the art of medicine?It ended with the advent of health insurance companies.

  • Eleanor Davis

    In the past 63 years, I have had all sorts of doctors, some wonderful, almost all competent, but very few who had (or have) the ART of medicine.  Three of them practice(d) as PAs under some invisible MD: one is civilian with father and brothers in medicine, and the other 2 are (were) military or naval medics.  I am extremely grateful to have found the latest one, since I am getting to the point where I need to be able to ask questions or just talk and get feedback in words that I understand.

  • http://twitter.com/thomasgetchius Tom Getchius

    Thank you for sharing the very important other half of the equation. We know it is not enough to just educate on the principles of evidence-based medicine, but rather, provide physicians and health care professionals with the available evidence and watch them and let them take it into account as they treat their specific patient.