Being an expert witness can be a daunting task, as I experienced firsthand. The experience left me disillusioned, not because of the grueling cross-examination, the questioning of my qualifications, or the inadequate compensation. No, my disillusionment stemmed from the need to defend the medical profession’s age-old tradition rooted in the “art” of medicine. This incident made me question the reliance on textbooks and evidence-based medicine, as well as the importance of compassion and understanding in healthcare.
The Lessons from Viktor Frankl
In Viktor Frankl’s powerful book, “Man’s Search For Meaning,” he introduced the phrase “Textbooks tell lies.” Those words struck a chord with me and reminded me of the physicians at Auschwitz concentration camp. Trapped in unimaginable conditions, they realized that the information in their medical textbooks had little relevance to the hardships they faced. There were no treatments for the illnesses resulting from the inhumanity they endured. Conversely, no textbooks could have predicted the surprising resilience of certain prisoners in the face of torture, famine, and disease. The concept of “resiliency” itself was absent from the medical literature of that era.
The Limitations of Evidenced-Based Medicine
As a staunch advocate of evidenced-based medicine, I found myself in a unique situation when asked to testify about the art of medicine. During the trial, I emphasized that medical practice encompasses more than what textbooks and journal articles teach us. However, the opposing attorney attempted to undermine my expertise, questioning my familiarity with evidence-based medicine. Despite his objections, the judge allowed me to testify, giving me the opportunity to defend the importance of compassion and understanding in healthcare.
The art of medicine is founded on in-depth knowledge of patients, their histories, and their unique circumstances. It involves listening to their stories, understanding their emotional and psychological well-being, and considering the impact of their social environment on their health. As a psychiatrist, delving even deeper into a patient’s life becomes essential. By acknowledging their personal relationships, their struggles, and their regrets, physicians can provide more holistic care. This is a dimension that textbooks and journal articles often neglect.
Treating patients as whole individuals, rather than a mere manifestation of their ailment, is at the heart of the art of medicine. This means addressing their mental and emotional health, as well as their lifestyle and personal circumstances. Offering empathy and concern can significantly enhance a patient’s healthcare experience and positively influence their health outcomes. Discovering the essence of a patient’s existence cannot be accomplished solely through textbooks; it requires a personal connection and understanding forged between physician and patient.
Challenging the System
In the case I testified for, the insurance company’s doctors denied necessary medical care without fully considering the patient’s unique circumstances. Their decision was based solely on medical guidelines, devoid of any personal knowledge about the patient. I argued that this callous approach to healthcare constituted practicing medicine in bad faith. Although the legal definition of bad faith did not entirely fit this situation, the judge recognized the importance of the art of medicine and compelled the insurance company into a settlement.
The art of medicine and the science of medicine represent two essential pillars of healthcare. While the science of medicine focuses on evidence-based solutions and objective approaches to diagnosing and treating diseases, the art of medicine is subjective and personalized. It involves understanding patients as individuals, empathizing with their experiences, and building therapeutic relationships. The art of medicine ensures that a broad knowledge of the patient is applied with compassion and cultural competence. It is the combination of both art and science that leads to effective medical practice.
Both physicians and patients would benefit from recognizing the significance of the art of medicine. While evidence-based medicine provides valuable guidelines, it should not overshadow the importance of the human aspect of care. Healthcare professionals should strive to understand their patients on a deeper level, taking into account their history, emotions, and surroundings. Patients, on the other hand, should be aware that the art of medicine goes beyond technical knowledge and embraces their unique experiences. The synergy between art and science promotes a more holistic and effective approach to healthcare.
My experience as an expert witness forced me to critically examine the art and science of medicine. The incident highlighted the limitations of evidence-based medicine, emphasized the need for compassion and understanding in healthcare, and showcased the importance of a comprehensive perspective. While textbooks and guidelines have their place, they cannot replace the deeply personal connection between physician and patient. The art of medicine will always be an integral part of our profession, and its value should never be underestimated.
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