β Scribed by Jerry G. Blaivas
No coin nor oath required. For personal study only.
Medicine is part science, part art. There is good science and bad science, but it doesn't seem that most of us know, or care, how to separate the two. Most science is bad science because it does not answer, in a convincing way, the questions it asks. Sadly, most bad science gets published in peer review journals.
The media has bought into the science of medicine (good or bad); the public, third party payors, patients, and, worst of all, physicians have all bought into it. That is why there is no shortage of medical technology and pharmaceutical companies selling things to treat benign and malignant prostate disorders such as lasers, heating colls, cooling coils, ultrasound devices, stents, anti-androgens, etc. and products for incontinence like biofeedback and electrical stimulation machines, bone anchors, valves, stents, inserts, plugs and even fancy tape to seal the urethral meatus till it's time to void. Alas, there is no shortage of physicians to prescribe and use these things nor is there a shortage of physicians to perform the latest modification of the newest gimmick in surgical technique.
Is this all bad? Probably not, it just could be a lot better. The possibility exists that somewhere in this mired muck of new stuff may be the next breakthrough. Everyone certainly hopes that the newest technologic advance will be this breakthrough, but no one knows how to tell. This means that it's okay to try these things but we should consider them clinical research, not new treatments. The research should be conducted in a rigorously scientific way so that the truth will become obvious.
But this editorial is about art, the art of medicine.
When it comes to medicine, art is not as Aristotle said, an imitation ofnature, it is something else. Art in medicine is clinical experience and judgement; it is compassion and caring; it is thinking and feeling. One attains the art of medicine not in training, but in practice. For the physician, it is taking a history, not reading a patient questionnaire. It is doing the physical examination; it is doing (not reading) an ultrasound. For the clinician, ultrasound is an extension of the physical examination. What better appreciation can you have of a pelvic or prostate condition than by doing the physical examination yourself, then looking at it (with an ultrasound), then operating on it, then looking at the pathologic specimen in the flesh and under the microscope, then talking to the patient and his family and feeling their pain or experiencing the joy of a successful outcome. Each time you do this, you learn a little bit. The more you do it, the more you learn. Sometimes, you make mistakes. Sometimes the mistakes are costly ones. If you are smart, you learn from your mistakes. After a while you develop experience. And judgement.
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