Recent article From the Sunday New York Times: "Doctor, shut up and listen!"

Jain, Bimal P.,M.D. BJAIN at PARTNERS.ORG
Wed Jan 14 12:30:08 UTC 2015


If we look upon science as a method of investigation, there is little doubt in my mind that diagnosis is more of a science than art. The essential feature of science is that it is a search for testable explanations and once such an explanation is found by observation or experiment it is agreed to by everyone. For example, if I see a patient with dispend and suspect pulmonary embolism, I perform a chest CT angiogram. If this test is positive, everyone would agree my suspected explanation was correct.
Clinical diagnosis is identical to the method employed by Richard Feynman, the great American physicist in his investigation of the explosion of space capsule Challenger in 1986. He carefully studied all available data about the explosion and suspected malfuncion of an O-ring,which functioned as a valve due to extreme cold weather (28 degrees F) as the cause of explosion. He tested his explanation with his famous experiment performed on television in which he dipped a replica of rubber O-ring in a glass of ice cold water and demonstrated it to lose its resilience convincing everyone he was correct.
The 'art' part in diagnosis and in other investigations occurs in suspecting fruitful explanations which may require creativity at times.

Bimal


Bimal P Jain MD
Pulmonary-Critical Care
Northshore Medical Center
Lynn MA 01904

-----Original Message-----
From: Robert L Wears, MD, MS, PhD [mailto:wears at UFL.EDU] 
Sent: Tuesday, January 13, 2015 1:06 PM
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
Subject: Re: [IMPROVEDX] Recent article From the Sunday New York Times: "Doctor, shut up and listen!"

I like this thought -- I've often thought that the 'medicine is an art -- no medicine is a science' 
debate is sterile and unfruitful.  In addition, assertions that 'an art' is involved tend to be dead ends, closing off rather than opening up discussion.

My own thinking is closer to David's -- medicine is neither art nor science, but rather a craft
-- a learned way of thinking and acting about illness and injury.  In that it is rougly paralle to engineering, which is also not a science, but rather an informed, iterative tinkering and assessing to try to make things better in some sense.

bob



On 12 Jan 2015 at 17:24, David Lawrance wrote:

> The practice of clinical medicine is neither art nor science. Those 
> things are both experimental. Whatever I do is not so much that. I 
> think I'm more of a skilled technician. My skills were largely 
> learned, but not taught. I have a lot left to master even after 35 
> years of practice. I wish what I did was experimental so that I could
> 

Robert L Wears, MD, MS, PhD
University of Florida  	Imperial College London
wears at ufl.edu		r.wears at imperial.ac.uk
1-904-244-4405 (ass't)  	+44 (0)791 015 2219
The kind of thinking got us into these problems is not likely to be the kind of thinking that gets us out.
                                              ---Einstein






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