Saturday, November 16, 2013
Welcome To The World of The Masters of The Clinical Arts
The marvels of modern scientific and technological medicine are taking over and pushing the clinical arts out of existence. Young doctors are learning to rely on that science and technology rather than their clinical skills and acumen. They are delegating responsibility to the tests and protocols rather than taking that responsibility themselves. They are losing confidence in their clinical skills and arts. Developing those skills and arts is less important to them; they are no longer a matter of life and death. That responsibility can be left to a machine or computer protocol.
That luxury was not available to the retiring generation of doctors when they trained and first practiced. Medical science and technology was in its infancy in the fifties and sixties. They only had plain x-rays and primitive, basic blood tests. There were almost no machines in hospitals, only human clinicians. There was nothing non-human to delegate responsibility to. Human doctors had to take that responsibility. There was no substitute for the clinical arts and they had to be developed to their pinnacle.
The past masters of the clinical arts learned their art first as a necessity. It was their foundation. As the science and technology came along, they were added gratefully to the doctor’s diagnostic and therapeutic armoury. They were kept in context with the pre-existing foundation of the clinical skills and acumen and perfected clinical practice. The human doctor still had overall responsibility and the science and technology were the tools that served them.
The masters of the clinical arts is fascinated and enamoured with the science and technology of medicine and how it can improve their clinical practice. Still, they hold it in the context of its only being a fragment of a greater picture that is painted by their art. It is still their servant.
This is more subtle than an either/or question of the clinical arts versus the science and technology of medicine. The mastery of the science and technology of medicine is one of the essential arts of medicine to form a synergistic and harmonious relationship between human and machine where the human is still in full control of their mechanical tools. Their master uses their tools as any craftsman, precisely and sparingly, only where necessary.
That confidence and ability is being lost at a time that it is more important than ever. Every scientific and technological investigation or treatment is known to carry a measureable risk, either a direct risk or an indirect on caused by further investigation and over-treatment. They must be used sparingly and only when they do more harm than good.