Thursday, August 2, 2007

Art and science

Several years ago to begin a remodeling project in our kitchen, I called an electrician to make sure that the existing wiring would be adequate for our needs. Our house was about thirty years old and an addition had been built on prior to our ownership. After a thorough inspection the electrician took us around the house showing us areas that were problems along with his proposal for fixing them.

Once the electrician had completed his presentation, my spouse began to tell him that we had a different plan. I began to laugh. This experience was so much like practicing medicine that I could not believe it. "Now, I don't do electricity," I said to the electrician. "People come to me for problems with their health." Yet I was struck by the similarity of situations. I knew from experience that I would either pay this man to do what he deemed best or get another electrician. He was there as the expert in his field. In hiring him we were asking him to assume some of the responsibility for the safety of the electricity in our home. Mistakes in his craftsmanship could result in a power outage in the least and a major house fire at the worst.

Patients often come to my office with a predetermine plan for treatment. What they would like to do is based on their symptoms, reading and/or talking with friends and their desired outcome. I listen to what they have to say and the process they have been through to come to those conclusions. This often helps me in making a diagnosis and planning treatment. At that point I often ask the patient if she is willing to trust the me to be the doctor. In most instances the patient will give me a chance.

However this is where the similarity between electrician and physician ends. Electricity is a constant. It behaves in a predictable way. Patients are not carbon copies of each other which happens to be one of my favorite aspects of medicine. Even a "text book case" is going to be different from what is in the textbook because each patient is an individual. I explain this to patients by trying to list for them as many possible outcomes as I can before they begin treatment. The some of the art of medicine is to do this in such a way that the patient will trust that his will be the best possible outcome. In some part of the success of a treatment is derived from the patient's expectations. I always include the fact that even if the risk of a complication is one in a million, if they have that complication it really doesn't matter what happened to the other 999,999 people.

Yes, medicine is a science. More and more with each new test or treatment physicians can be technicians. In the skill that comes with increased knowledge in the science of medicine I pray that as physicians we will continue to excel in the art of medicine as well.
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1 comment:

The Local M.D.'s Son said...

Great comparison between the electrician and a physician. It's very well written and interesting.

Love you!