Art or Science? The dubious duality of Medicine.

It is a long debate if medicine is ought to be practiced as an art or science. In order to set the standards right, we need to settle on the meanings of each. Science is a systematic study of the universe to identify patterns and make predictions. The accuracy of a particular science depends on how closely outcomes match predictions. On the other hand, art is non-systematised, individualistic expression not bound by patterns or formulae. Art is a free-hand depiction; while science is drawn with ruler and scale. Art cannot be taught, but only be practiced over and over again. The mastery gained depends on how gifted the individual is. In contrast, science is objective and can be taught to anyone-be it human or a computer algorithm.

During the discourse involving medicine, art and science,art is too often exclusively endowed with humane emotions of compassion, empathy etc. Science on the other hand is seen as dry, dull and mechanical. A hollow set of rules bereft of inner human touch. This bias could be the result of a shallow understanding of the terms. One needs to be careful not to fall into this bigotry. If you were science you would be strongly protesting this injustice. Actually, science grows over centuries one miniscule concept at a time. It takes co-ordinated efforts of countless humans, across geographical and time-scales to develop science. And what is the motivation of all these devout zealots of science? To solve mysteries of existencenot so much for fun as for solving human challenges. How then, can anyone brand science as devoid of human compassion? And what science other than medicine could possibly demonstrate a direct descent from empathy to fellow humans? It is due mainly to the tremendous success of science that modern medicine is accepted today all over the globe. It is noteworthy that civilisationsthat have nothing in common with respect to religion, political structure or economic model, follow same physiological and microbiological concepts in their hospitals. Imagine, if it were not for science, we would not have doctors; but only witch-doctors.

There are reasons why the distinction between art and science blur in medicine. Firstly, we have not been able to decode human body and mind completely yet. Medical science does not have all the answers. It is an incomplete science. Hence medical professionals often cross over to art in a desperate effort to seeksolutions. NASA might not need art to place a satellite in the exact orbit desired. They have it all figured out. Doctors have not. Indeed, most scientific advances in this field start off as reach-outs for solutions beyond the gambit of known science. The art that an experienced professional successfully practices is the result of subconscious learning that has occurred over a long time beyond the realms of that individual’s own realisation. If only we could hack that master’s subconcious, we can de-mystify art into science, and disseminate the knowledge to help all of the mankind. This is no science fiction, but actually happens perpetually in medical field, only through less dramatic ways of clinical trials, statistical analysis etc.

Second reason for having to utilise art in the practice of medical science may be found in the three ‘P’s of medicine. Philosophy; Principles; and Practice. As science, we learn in medical schools and symposia, only the principles of medicine. They have been fairly strongly laid down for the day although they keep changing or upgrading from time to time. Barring a few heated arguments on the podia of medical conferences, the principles are agreed upon unambiguously and constitute science. However, it is the ‘practice’ on ground that demands a lot of art. It helps to remember that we practice ‘western medicine’ in the land that is nowhere near the west. If medical science is incomplete, so are the others like political science, social science, behavioural and economical sciences. Until we achieve a grand unification of all these sciences and derive precise coefficients of corrections, the principles of medicine need to be filtered carefully through the existing situations on ground for effective practice. That, readers, takes an awful amount of art.

Yes, I am wantonly avoiding the bigger ‘P’- the Philosophy. Believe me, you don’t want to go there today.

So how much of medical practice is science and what portion is art? Again, it is a function of time. At any given time period, medical practice hovers somewhere on a spectrum stretching from pure art to pure science. Centuries ago, it was mainly art. Subjective, secretive and unquestionable. We saw it turn into more of science; created some disillusionment; then turned towards art for help. Now it is more fashionable to refer to ‘art of medicine’. It sounds rather poetic. But times are changing again. In the era of medico-legal inquisitions, it is safer for medical practitioners to stick to verifiable science to the extent possible. It might also help to speed up giving scientific validation to whatever art form we nevertheless do practice and to demand as a right, greater artistic freedom for the practitioner. Striking a right balance amidst a plethora of variables is what makes the practice of art and science of medicine, an enticing enterprise.

P.S. The author’s field of aesthetic surgery is not to be misunderstood as mainly art. It has no less science than other fields of medicine and has only slightly more artcomparatively.

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