Professional Documents
Culture Documents
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
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
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
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
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
2
conclusion that medicine is, and should be, primarily an art. I will then present a few
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
the performance of a variety of tasks (Marinov). These differ from traditional mobility
enhance a physical rehabilitation program and is not used after completion of the
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.
3
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
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
4
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
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
Angela’s life. The physician could also attend to Angela beyond the physical by
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
5
the patient so that the physician can analyze all of the factors that may be affecting the
patient’s condition.
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
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
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
6
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
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
If this were the case, anyone with a full knowledge of physiology would be a physician.
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
7
during someone’s last time on earth signifies importance and should be incorporated
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
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.
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
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
9
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.
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
Understanding that they will not be able to save everyone will help ease their pain as well
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
In conclusion, despite all of the advances in the medical field, medicine remains
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
10
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
Works Cited
Cassell, Eric J. The Nature of Suffering and the Goals of Medicine. Oxford University
Press, 2004.
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.