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Rachel Brady

Dr. Lomelino

Philosophy 369

12 December 2017

Change is the only constant. This notion was first proposed by ancient Greek

philosopher Heraclitus in 500 B.C.E. and still resonates true today (Mark). Medicine has

evolved immensely over time. Scientists work tirelessly to develop new treatments and

technologies. Our scientific knowledge has expanded greatly, allowing medicine to stray

away from bloodletting and peg legs. Instead, medicine has progressed into modern

technologies such as rehabilitative exoskeletons. I think most people, myself included,

are grateful for these medical advancements. They have given us more effective

treatments and less painful techniques. While these scientific advancements are an

integral part of medicine, there is another force that remains even more vital: realizing the

practice of medicine is treating humans. Advances in medical technology have expanded

the scientific knowledge that practitioners must learn. However, these advances have not

changed the fundamental principle of medicine, which is that science is essential, but

medicine should not be reduced to science alone. Even with extensive advances in

medical technology, medicine remains predominantly an art.

In order to argue that medicine is predominantly an art, I will reflect on the roles

of both science and art in medicine. To illustrate my point, I will draw on the

technological advancement of rehabilitative exoskeletons periodically throughout this

paper. I will also reference a case study I created in class to further explain my stance. I

will begin defining some basic terms, followed by briefly explaining rehabilitative
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exoskeletons and my case study. Next, I will present my arguments in support of my

conclusion that medicine is, and should be, primarily an art. I will then present a few

common objections to my conclusion. Finally, after discussing these objections I will

offer my responses to those objections.

I will be referring to medicine as a balance between science and art. Science in

this paper indicates empirical facts, objectivity, and the ability to be universalized. It

centers on evidence-based medicine. The term art will be used to describe the subjective

skills of physicians. It includes, but is not limited to, physicians’ intuition, professional

etiquette, and approaches to the doctor-patient relationship. I will also reference the term

embodied self. The term embodied self is the way the patient sees him or herself. It is

their sense of identity, which includes, lifestyle, activities, beliefs and other personal

details

Rehabilitative medical exoskeletons are a relatively new medical technology first

developed in the 1960s and implemented more commonly in rehabilitation regimens

beginning in 2010 (“A Brief History of Robotic Exoskeletons”). Rehabilitative medical

exoskeletons apply robotics and biomechanics towards the augmentation of individuals in

the performance of a variety of tasks (Marinov). These differ from traditional mobility

aids such as wheelchairs, crutches, or scooters because a rehabilitation device is used to

enhance a physical rehabilitation program and is not used after completion of the

program. Rehabilitative exoskeletons are devices worn externally to enhance a patient’s

rehabilitation process following an injury. These devices provide support for the patient

and usually resemble the skeleton of the body part they are attached to. Exoskeletons

range in size and shape depending on the area of the body they are meant to rehabilitate.
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A mobility aid is a more permanent device because they are generally used when the user

is not expected to make a recovery. Mobility aids aim to make the user’s life easier when

the user is coping with permanent mobility difficulties. The goal of rehabilitative

exoskeletons differs, and instead aims at rehabbing the patient back to independent

mobility.

The case study I created in class revolves around a patient named Angela

Rodriguez. She is a 34-year-old war veteran who was injured in combat resulting in the

amputation of her right foot. She is Latina and lives in Austin, Texas with her husband. In

the case of Angela, she could benefit from a rehabilitative exoskeleton to enhance her

recovery.

Asking the patient what brought them in is a common way of beginning the

doctor-patient relationship. From there the physician chooses an art or a science

approach. I believe medicine is primarily an art because it addresses individual aspects of

the person, particularly the details that cannot be generalized such as mental state, living

conditions, and social context of an individual. These details better inform the physician

about possible diagnoses, potential implications of treatments for the patient’s quality of

life, as well as build trust between the patient and physician. The subjective, individual

aspects of a patient can be referred to as the patient’s narrative. An art approach collects

the necessary, scientific details, as well as the patient’s narrative by showing interest in

the patient outside of their physical symptoms. To do this, the physician must make an

effort to understand the patient’s embodied self, “For medical practitioners, increased

awareness of evaluative and identity concepts engenders the capacity to generate their

own social insights that evolve out of analysis of actual medical encounters rather than
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drawing them from aggregated social science knowledge of the statistical or conceptual

variety that they may have been taught” (Wasserman 15), by asking about hobbies and

general lifestyle, the physician builds a deeper relationship with the patient while also

collecting more information that may prove relevant. Understanding the particulars of the

patient, instead of generalizing facts from social science studies, is essential to practicing

medicine as an art. Getting to know the patient and understand their embodied self allows

the physician to more accurately decide on the best course of treatment.

Upon initial consult with Angela, the practitioner should collect statistics about

her as well as briefly talk to her as more than a clinical patient. After speaking with her

quickly the physician would learn she is married, but that her husband often travels for

work. Learning these two simple facts clues the physician in about Angela’s support

system at home. Asking about her hobbies leads the physician to learn that Angela is very

active and that the loss of her foot must be taking a huge toll on her not only physically

but also psychologically. The physician might start to consider possible mental health

implications Angela may also be dealing with. Right now Angela probably does not see

herself as the same active person that she was prior to her injury. This idea references the

concept of embodied self. The physician only needed to ask three additional questions to

learn much more about Angela and her suitability for an exoskeleton. The physician is

better equipped to prescribe an exoskeleton after knowing more of the context of

Angela’s life. The physician could also attend to Angela beyond the physical by

recommending counseling prior to physical rehabilitation or in conjunction with physical

rehab. A physician’s intuition and ability to pick up on nonverbal cues goes a long way in

making the patient more comfortable and ultimately learning as much as possible about
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the patient so that the physician can analyze all of the factors that may be affecting the

patient’s condition.

A science approach would be collecting information about the necessary,

objective details such as symptoms, basic medical history, and vitals. If the physician had

only addressed Angela’s physical symptoms, they may have missed the potential

psychological consequences underlying Angela’s condition. “science tends to work

toward increasing specialization or differentiation, whereas art tends to work toward

integration” (Wasserman 5), in this case the physician separates Angela’s embodied self

from her physical injury of her amputation. The artistic approach to medicine integrates

Angela’s life outside of her injury as well as her amputation to design a treatment

protocol. Simply showing interest in the patient beyond their symptoms is a small act of

authenticity that can make a huge difference in the quality of patient care.

To further expand on the need to use an art approach to tend to the whole person

rather than symptoms of a patient, I will discuss the priorities of hospice care. End of life

hospice care focuses on personalized medicine. If this kind of medicine is valued in

someone’s last moments should it not also be prioritized throughout that person’s life?

The practice of medicine is essentially humans treating humans; technology only goes so

far. When technology falls short, medicine does not stop. In cases that patients cannot be

cured by medical technology, such as hospice care or chronic illness, practitioners shift

their focus to comfort care. In my patient case, Angela is coping with a chronic illness of

losing her foot and the psychological implications of such a loss. Comfort care is an

integral part of treating the whole person rather than symptoms. A physician’s role should

be to reduce suffering of the patient. According to Eric Cassell, “suffering occurs when
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there is a threat to the integrity of the person or a loss of the part of the person” (Cassell

44). In order to understand how a person suffers, the physician must understand what

gives the patient meaning in their own life; how will potential implications of treatment

courses alter the patient’s sense of self. Hospice care encourages the patient to decide

what makes their life worth living and then the physicians provides care that centers on

those values.

Technology can be applied in a way to treat the patient beyond their symptoms by

encompassing their values. To apply technology in the correct manner the physician must

use an artistic approach to discover the patient’s values. Physicians should use hospice

caregivers as a model for how to implement technology in a way that is consistent with a

meaningful life and integrity for the patient. In the case of my technology, rehabilitative

exoskeletons can be used to reduce suffering by restoring a patient’s physical

independence. However, if physical independence is not as important to the patient as for

example, safety of not falling, then a rehabilitative exoskeleton may not be an appropriate

treatment. Defining medicine as a science alone does not allow the physician to learn the

aspects of self that a patient has, and therefore the physician cannot adequately reduce the

patient’s suffering. Medicine as a science implies medicine can be learned in a classroom.

If this were the case, anyone with a full knowledge of physiology would be a physician.

Medicine as an art is able to draw from evidence-based medicine, such as the

effectiveness of medical technologies, and also assess whether they are appropriate for

the patient in accordance with the patient’s priorities. Looking to hospice care

professionals as a framework for how to treat patients is important because what is valued
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during someone’s last time on earth signifies importance and should be incorporated

throughout the individual’s life.

A third reason why art is necessary to the practice of medicine is it allows

medicine to acknowledge and accept uncertainties. Science is an inference to the best

explanation. However, many people misinterpret science as fact. In reality, science is

constantly changing as researchers make new discoveries. It is a dynamic process that can

provide patients with a false sense of certainty. Assessing scientific variables alone can

oversimplify the symptoms of a patient. Using an art approach, the physician takes in

more relevant information about the patient. Therefore, the physician understands the

whole picture of why the patient is suffering. A science approach may also lead to

overconfidence of the physician. If they identify one problem they may not search any

further for possible explanations. Acknowledging that each patient is composed of more

variables than scientific statistics is actually freeing. First, it encourages more questioning

by the physician to understand the context of the patient that brought them in to the

office. Secondly, understanding there are uncertainties keeps the physician more open-

minded to alternative diagnoses and treatments. Thirdly, the physician understands there

is always more to learn about a given situation, which could create a more humble

physician. Humble physicians have more open and trusting relationships with their

patients because they are approachable. Humility also allows for better collaboration

among healthcare professionals. A physician that acknowledges they do not have all of

the answers is more apt to seek advice from their colleagues. Both of these aspects will

contribute to better patient care. Approaching medicine as a science is dangerous because


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of the false sense of certainty it can provide. If there is a surface level scientific answer

present, physicians may not feel compelled to question results or dig any deeper.

Utilizing an art-approach invites the physician to become more involved in the

patient’s case, resulting in a more comprehensive treatment. For example in my patient

study, Angela’s mobility could be improved by using a rehabilitative exoskeleton. A

physician may prescribe physical therapy using the exoskeleton three times a week, a

seemingly straightforward course of treatment. If the physician looked no further than her

amputation, they may miss that Angela has been exhibiting behaviors consistent with

PTSD. Her depressive mood may inhibit her from significant progress during therapy.

Increasing her time with the exoskeleton would not be beneficial in this case. The ability

of the physician to pick up on cues that Angela does not specifically state is a necessary

requirement for Angela to receive the best care. Medicine as an art facilitates open

dialogue between Angela and her physician that will aid the physician in tending to

Angela as a whole, rather than her amputation alone.

The first possible objection to my thesis that I will address is that a science

approach to medicine is efficient. Physicians are able to treat more patients if they omit

the art aspect of medicine. From a practicality standpoint, there are limitations to the

amount of time a physician can dedicate to each patient. My response to this is that it is

not possible or necessary to learn everything about each patient. Instead, it is about the

relationship the physician fosters with the patient. A physician should acknowledge the

patient as more than a list of symptoms and therefore understand that the course of

treatment will affect the patient outside of the doctor’s office. The goal of medicine as an
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art is to make the patient feel comfortable to offer up additional information that may

prove relevant to the case. The timing of this comes with experience.

The second objection I will analyze is that objectivity is needed to be a good

physician. To practice medicine well and without bias, a physician should not get

emotionally invested in each case, which is more likely with a definition of medicine as

an art than medicine as a science. My response to this is twofold: first, it is necessary for

physicians to compartmentalize, which is a skill that is developed with practice and

experience. It is important for physicians to recognize their own limitations.

Understanding that they will not be able to save everyone will help ease their pain as well

as keep them humble. As mentioned before, humility is important to better doctor-patient

relationships and to improve collaboration among physicians. Second, it is impossible for

humans to be completely objective. Each situation we enter, we bring our own social

context. Science appears completely objective; however, there is still some degree of

subjectivity simply because researchers choose what to focus on. Also, it can be argued

that even scientists, not practitioners, exhibit subjectivity during their research. A

researcher’s passion for their life’s work may elicit just as much emotion as a physician

caring for their patient. Being human it is impossible to remain completely objective. To

address this, we must equip our future and current physicians with tools to recognize their

own biases and control them appropriately.

In conclusion, despite all of the advances in the medical field, medicine remains

predominantly an art. Practicing medicine as an art emphasizes the importance of

patients’ narratives, which allows the physician to come up with a treatment plan better

suited to the needs of the patient as a whole. Secondly, an artistic approach to medicine
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focuses on personalized medicine. Personalized medicine is valued in hospice care during

a patient’s final moments, signifying its importance. Because of this it should also be

incorporated throughout a patient’s life. Finally, medicine as an art also allows physicians

to acknowledge uncertainties in the medical field while medicine as a science may lead to

a false sense of certainty.


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Works Cited

“A Brief History of Robotic Exoskeletons.” EduExo, 2017,


www.eduexo.com/resources/articles/exoskeleton-history/.

Cassell, Eric J. The Nature of Suffering and the Goals of Medicine. Oxford University
Press, 2004.

Mark, Joshua J. “Heraclitus_of_Ephesus.” Ancient History Encyclopedia, Ancient


History Encyclopedia, 14 July 2010, www.ancient.eu/Heraclitus_of_Ephesos/.

Marinov, Bobby. “42 Medical Exoskeletons into 6 Categories.”Exoskeleton Report,


Exoskeleton Report, 1 Feb. 2017, exoskeletonreport.com/2016/06/medical-
exoskeletons/.

Montgomery, Kathryn. How Doctors Think: Clinical Judgment and the Practice of
Medicine. Oxford University Press, 2013.

Wasserman, Jason A. “On Art and Science: An Epistemic Framework for Integrating
Social Science and Clinical Medicine.” Journal of Medicine and Philosophy, vol.
39, no. 3, 2014, pp. 279–303., doi:10.1093/jmp/jhu015.

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