Thursday, July 28, 2011

Between Art and Science Sits the Patient

‘Ars longa, vita brevis’.

The Latin inscription is above the entrance door to the Postgraduate Medical Centre at the Hull Royal Infirmary. It is a salutary reminder to the physicians and surgeons who gather there in the pursuit of furthering their medical knowledge. Translated into English, the phrase enjoins us to remember that ‘art is long, life is short’. The original quotation was not in Latin but in Ancient Greek, and can be found at the beginning of a medical text book written by that well-known ancient physician, Hippocrates. The rest of his quotation reminds us that ‘opportunity is fleeting, experiment dangerous, and judgement difficult’.

Although written sometime between 460 – 370 BC, Hippocrates’ aphorism is as pertinent now as it was 2,400 years ago. The ‘art’ he speaks of is not that which we would commonly think of as art today (paintings, sculptures, literature etc.). Hippocrates’ art is the art of medical practise, and in the early years of the 21st century medicine remains just that; an art. Today, however, the modern physician would extend the concept by saying that medicine is ‘an art based on science’. The word science is also of Latin origin, meaning ‘knowledge’. The phrase ‘evidence-based medicine’ is perhaps the commonest way modern physicians refer to the inter-relationship of art and science when applied to medical practise.

What this all means is that medicine is far from being able to offer a perfect solution to every single ailment that besets humankind. In the consulting room, the most a doctor can be expected to do is to diligently apply (the art) the most contemporary knowledge (the science) to a patient’s presented problem. Sometimes great cures are brought about; occasionally there is little that can be done; more often than not, the work of the doctor is to modify the symptoms suffered by the patient in order to make life more pleasurable. The latter is summed up in another (19th century) aphorism: ‘to cure sometimes, to relieve often, to comfort always’, which neatly returns our thoughts to Hippocrates and his idea that ‘judgement is difficult’.
Doctors make judgements all the time; judgements are the end results of their application of art and science to patients’ problems. Judgements are not perfect and, ipso facto, neither are doctors or medicine; which is one reason why I believe that it is the duty of responsible newspapers not to be over-dramatic about small gains in medical science. Often a small scientific gain presents doctors with just another tiny piece of knowledge in the vast jigsaw of medicine, based on which judgements are made. It is rare that significant life-changing discoveries are made which will greatly influence the treatment of today’s patients.

A good example is the recent national press coverage of how the effects of certain drugs in combination can (by something called their anticholinergic effect on the nervous system) increase the risk of cognitive impairment (confusion and dementia-like symptoms) and death in people over the age of 65 years. No doubt my colleagues across the country had patients arriving in surgery clutching those newspaper cuttings, anxiously querying the effect of their drugs. The fact is the survey was based on drugs commonly used in the early 1990s. Twenty years later, many of those drugs are no longer used, or are rarely used in the combinations stated. Science has moved on and thus, too, has our art.

When I was a cub scout in the 1960s, we would salute our Arkela with the words ‘Arkela...we’ll do our best’. As far as doctors are concerned, the words of Hippocrates are more erudite than the ‘grand howl’ of the cubs. Nonetheless, the meaning is the same. Patients...we’ll do our best; but please remember we practise an art based on science; a science which is not, and never can be, perfect.

First published in the Scunthorpe Telegraph, Tuesday 12th July 2011.

1 comment:

Derek said...

Nice post thanks for sharing.
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