How is Medicine an Art? AKA The Most Powerful Sentence a Teacher Told Me in Residency

What do we mean when we say medicine is part art? As clinicians, we say this a lot. Do we actually stop to think about what it means that medicine is an art?

In contrast, we can easily see how medicine is a science. We rely on evidence, on data. We have lots of data from research. Research can tell us a lot about what the effective therapies for a condition are, what optimal drug doses are, the optimal timeframe for surgical repair of an injury, etc.

Medicine as an art is more vague.

Let’s discuss what art is a bit first. We can think of art as an expression of the artist’s self. Each artist will express themselves differently in communicating the same idea. Consider if we asked several people to paint a picture of the same sunset. We’d give each painter the same set of paints and let them watch the same sunset. They’d all paint the same sunset, but somewhat differently. Each one would express their own version of the sunset, but they’d pretty much all be able to communicate the sunset.

So how does this apply to practicing medicine?

In much the same way as the hypothetical painters, clinicians use the same set of tools to arrive at their objectives… but sometimes in a different way. We may all have preferences, but in many situations there is more than one reasonable way to do the same thing.

The science is our tools. The art is how we use these tools. There can be more than one reasonable way to use the tools to meet the goal. However, the goal is still the same.

Another way to think of this is the most powerful sentence that one of my teachers used with me after I’d finished presenting a patient. He would say, “That’s reasonable”. What I realized he meant was that although his plan would have been different, my way also made sense… just like there is more than one way to paint the proverbial sunset.

A couple of simple examples will illustrate this.

We have a patient with gastroenteritis. It’s reasonable to start an IV, provide IV antiemetics, provide IV hydration, and discharge when the patient feels better. It is also reasonable to provide IM antiemetics, observe the patient, and discharge when they tolerate oral hydration. Both approaches have different merits and different drawbacks. However, both are reasonable ways to approach the same problem.

We have a patient with a vague abdominal pain. It’s reasonable to do a quick history and physical, get a CT scan, and discharge if the CT is negative. It’s also reasonable to do a thorough history and physical, specifically look for concerning findings, observe the patient, re-examine the patient for worsening exam, and discharge if there are no concerning findings. Again, both approaches have different merits and different drawbacks. However, both are reasonable ways to start approaching the same problem.

Every approach will have different pluses and minuses. Some ways will be longer, shorter, less painful, more painful, more expensive, less expensive, etc. In some situations, one approach may clearly be preferable to the others. However, in many situations more than one approach will be reasonable.

Different clinicians will have different preferences for the way they use their tools when there is more than one reasonable approach. Thus, we have many different “styles” of practice (of using our tools) and as long as they are reasonable, that’s ok.

If you’re interested in learning more about this topic and other processes behind making clinical decisions, check out my book: A Guide to Clinical Decision Making