Yes HANS DUVEFELT
The Art of Medicine is such a common phrase because, for many centuries, medicine has not been a biscuit-cutting activity. It was a personalized practice, based on the science of the day, practiced by individual physicians for several patients, one at a time.
Unlike industrial mass production, where everything from raw materials to tools to manufacturing processes are standardized and even automated or made by robots, doctors work with raw materials of different ages, shapes and qualities in what is most like and restoration of damaged paintings or antique cars.
The art of Medicine involves knowing how and with what tools to pick up something damaged or malfunction and make it better. There are general principles, but each case is different to at least some degree. In many cases there are several ways to improve something that is not working well, but patients may prefer to fix certain aspects of a complex problem because of their individual needs.
Restoring a very old car can be a different procedure depending on its intended use, such as parading in car shows or driving the field through. Patients ’wishes and expectations may vary equally.
The vision on optimal treatment of high blood pressure has become a vision of automation to the point that many have proposed to let pharmacists follow the protocols, actually prescribing and dispensing medications for better control.
But patients are not generally embedded in such manufacturing mode paradigms. Some patients with hypertension also have swollen legs, rapid heart rates or low blood pressure points when they feel stressed. Some have naturally low potassium levels or cold feet in winter. A careful and individualized choice of medication for blood pressure can make the whole person feel and function better, treating more than one thing at a time. Knowing all the medications available intimately is infinitely more valuable to the patient than following the blind treatment algorithm of the day – because we’ve all seen them come and go.
To paraphrase Hippocrates: The Life of Algorithms is short, the Art of Practice is long.
Hans Duvefelt is a Swedish-born rural family physician in Maine. This post initially appeared on his blog, A Country Doctor Writes, here.