Modern Medicine Whither to? Over the last three decades, I have witnessed bewildering progress in medical science. While some diseases have been eradicated, others have cropped up, or remained as they have for ages. Scientific discoveries, innovations and genomic medicine have transformed the way we approach a patient. From the moment a patient enters a hospital he is subjected to a spectrum of technological studies including scopies, to peer within the human body, to visualize nature’s beauty, hitherto hidden to the naked eye. In spite of all these advancements the patient is very often left in despair and confusion. He craves for the personal touch and a heart to heart talk with his doctor. Modern day medicine with all its glorious superlatives has left a wrinkle in our confidence. A fundamental question remains unanswered. Is medicine an art or a science?
What is scientifically “True and Correct” today may not be relevant tomorrow. Dogmas change and approaches to disease management swing from one end to the other. In the fifties, an atom was considered the most indivisible form of matter; there can be nothing far from the truth these days!
In Orthopaedic practice, the concept of healing of a fracture is a case in point. In the sixties, when I started my career, fracture healing was thought to be perfect with “natural healing with callus formation”. In the eighties, I preached and practiced anatomical reduction and surgical fixation. Healing without a callus became the end point to ensure bone healing with normal function. Now the wheel has turned a full circle to revert to callus formation and the accent is on maintaining length, alignment and rotation.
Changing Patient Care
These experiences make me think of patient care in a whole new dimension – a combination of fluidity, complexity and dynamism. Healing is a by-product of the patient-physician relationship as much as it is due to the complex medical parameters that govern the series of events that start with disease and end with cure, morbidity or mortality.
A protocol based and algorithmic approach, chasing shadows, perusing lab data and above all paucity of time have estranged the patient – doctor relationship. Decisions are made by us in cozy cold, closed chambers very often without the patient in view. We deliberate inside, while the anxious patient waits outside and sends a prayer to the Almighty, hoping for the right decision to be made. The ritualistic methods of history taking, clinical examination, developing a working clinical diagnosis and finally deliberation and contemplation have become a relic of the past. They have been sacrificed on the altar of evidence based scientific medicine!
The Power of Touch
The sanctity and intimacy of physical examination legitimate the human connection and this is most powerfully mediated through touch. Touch is a primal and potent act, beyond skin to skin contact, and engages in the emotional domain called praxis. If we apply Newton’s third law, touch is always reciprocal!! Touch has an affective dimension to care, the power of which extends beyond words. The power of laying hands in healing was known since the time of Asclepius, the legendary Greek god. The Bible reminds us that those who touched Jesus and those who were touched by Him were healed. Nowadays, touch has gained a different connotation. In today’s era of marketing and gimmickry – it is a word that encompasses only the jargon – “Stay-in-touch-marketing”.
It is in this context that the concept of human touch gains significance. It sends across a message of assurance to the patient that we are available to them at all times, and that we stand fully committed to stand with them, through thick and thin! We wish to emanate empathy from our dealings with patients. Communication – both verbal and non verbal is crucial to the success of this motto. Any dilution of this standard, puts us at discomfort and the risk of even litigation.
While we surge forward into the modern era of medicine, we need to clarify to ourselves that medicine is an art based on science. It cannot be practiced as an inanimate, heartless, scientific exercise. The utilization of the five senses along with the effective integration of cerebral faculties makes it the perfect recipe for a successful patient – doctor relationship and thereby satisfactory patient outcomes. The quest is short if we realize that the practice of medicine is an art that is played on the solid stage called science.
The sight of a new born baby is a marvel and a mystery. But isn’t the mystery of creation the true source of all art and science? Albert Einstein, the great scientist and philosopher once said “The most beautiful thing we can experience is the Mysterious. He to whom the emotion is stranger, who can no longer pause to wonder and stand wrapped in awe is as good as dead – his eyes are closed. The insight into the mystery of life, coupled though it be with fear, has given rise to science as it has to religion”.
May I ask — Modern Medicine, Quo vadis?