The practice of clinical medicine as an art and as a science

Saunders, John

doi:10.1136/ewjm.174.2.137

Cited by 26 publications

(33 citation statements)

References 7 publications

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“…Knowing is an art; science requires personal participation in knowledge". 2 This reminds us how contemporary medical thinking and practice remains heavily influenced by a nineteenth century view of scientific rationalism, ". .…”

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“…2 The quotation opening John Saunders's account of the art and science of medicine illustrates a compartmentalised view of medicine-the "art" of medicine being restricted to the moral dimensions of care centred on the human faculties of the doctor: "... the ability to listen, to empathise, to inform, to maintain solidarity: for the doctor, in fact, to be part of the treatment". 2 Saunders suggests the "art" of medicine extends further, indeed that " . .…”

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Patient centred medicine: reason, emotion, and human spirit? Some philosophical reflections on being with patients

Evans¹

2003

Med Humanities

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The ideal of patient centred medicine remains only partially realised. Within modern Western society, the highly individualistic culture and religious decline linked with medicine's reluctance to relinquish an outmoded form of scientific rationalism can act as reductive influences, stifling conceptual development. Some examples of the recent literature on communication skills in medicine are analysed to discern the underlying philosophy. A rationalist stance invites an examination of the possible nature of rationality. Another example accepts the need to accommodate the emotional and the unconscious. Issues of human suffering with an inherent spiritual dimension seem to remain excluded. The need to move beyond a duality of reason and emotion to embrace the existential and spiritual is suggested as a theoretical prerequisite for developing a more inclusive concept of patient centred medicine, which only then may be realised. Some brief examples are considered of the sort of notions and types of discourse that might effectively inform “teaching” of communication skills.

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Patient centred medicine: reason, emotion, and human spirit? Some philosophical reflections on being with patients

Evans¹

2003

Med Humanities

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“…There is a fixed component of performance, that derives from the rules imposed on the activity's practice and the existence of international performance protocols which must be present (Adler et al 2003;Reay and Hinings 2005;Haidet 2007;Saunders 2000).…”

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Improvisation in Tightly Controlled Work Environments: The Case of Medical Practice

Batista

Cunha²

2008

SSRN Journal

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We present a qualitative analysis of organizational improvisation and provide a preliminary insight into the following question: how is improvisation present in tightly controlled work environments? We conducted in situ observations of, and interviews with, several emergency medical teams and complemented this information with statistical and media data. Using grounded theory, we developed four propositions that were arranged into a model that allowed the identification of two use levels of established routines: (1) the visible side that accommodates contextual requirements, and (2) the improvisational side that provides a response to activity characteristics. This dual process is related to the existence of pressures that operate at the institutional level with practical needs emerging from the operational domain. In contrast with most of the literature, this study reveals that the presence of a broad procedural organizational memory does not restrict improvisation but enables a bureaucratic system to produce flexible improvised performance.

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“…, Waymack 2009 ;Saunders 2000 ;Cassell 1995 ;Malterud 1995 ;Battista et al 1994 ), which threatens to distance work in this fi eld from important progress elsewhere in philosophy, especially in philosophy of science. 9 That is, given the progress made in recent years on the question of whether science is valueladen or 'purely objective' in philosophy of science, if philosophy of medicine ignores this work it adopts an antiquated theory of science, which threatens to render it obsolete.…”

Section: Objectivity and The Scientifi City Of Medicinementioning

confidence: 99%

Objectivity, Scientificity, and the Dualist Epistemology of Medicine

Cunningham

2014

Classification, Disease and Evidence

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This paper considers the view that medicine is both "science" and "art." It is argued that on this view certain clinical knowledge -of patients' histories, values, and preferences, and how to integrate them in decision-making -cannot be scientifi c knowledge. However, by drawing on recent work in philosophy of science it is argued that progress in gaining such knowledge has been achieved by the accumulation of what should be understood as "scientifi c" knowledge. I claim there are varying degrees of objectivity pertaining to various aspects of clinical medicine. Hence, what is often understood as constituting the "art" of medicine is amenable to objective methods of inquiry, and so, may be understood as "science". As a result, I conclude that rather than endorse the popular philosophical distinction between the art and science of medicine, in the future a unifi ed, multifaceted epistemology of medicine should be developed to replace it.

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The practice of clinical medicine as an art and as a science

Cited by 26 publications

References 7 publications

Patient centred medicine: reason, emotion, and human spirit? Some philosophical reflections on being with patients

Patient centred medicine: reason, emotion, and human spirit? Some philosophical reflections on being with patients

Improvisation in Tightly Controlled Work Environments: The Case of Medical Practice

Objectivity, Scientificity, and the Dualist Epistemology of Medicine

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