Promoting Clinical Policy Change: Using the Art To Promote the Science in Medicine

Abstract

At the time of Sir William Osler, the task at hand was to remind practitioners and public alike that medicine had a scientific basis at all. How the pendulum has swung. The years of the twentieth century have seen the public and profession become comfortable with, and indeed presume, the notion of medicine as science, and the task is now to remind all that medicine still has a significant component of ‘art’ (Greer, 1987). The phenomenal increase in the role of the basic sciences in medical research, the proliferation of exacting technologies, the ever-burgeoning knowledge base found in journals, and the messages given by the profession itself, all present a coherent image of medicine as an engineering concept in which symptom x is carefully diagnosed as caused by factor y, which will yield with assured probabilities to treatment z. There is no room for the art of medicine in the image, for if there were, there would be an acceptance of discretion, of fallibility, of uncertainty, and of apparent irrationality and inconsistency in the practice of medicine. With such acceptance would come questions of effectiveness of all that is done in the name of medicine, and of the advisability of public financial support for all that is contained within that Pandora’s box of ‘medical practice’.

To the physician particularly a scientific discipline is an incalculable gift, which leavens his whole life, giving exactness to habits of thought and tempering the mind with that judicious faculty of distrust which can alone, amid the uncertainties of practice, make him wise unto salvation. For perdition inevitably awaits the mind of the practitioner … who has never grasped clearly the relations of science to his art, and who knows nothing, and perhaps cares less, for the limitations of either.

Sir William Osler, 1894