investigation here, and American investigators have had to go to Scandinavia to obtain access to properly kept records of this kind, which have shown beyond a doubt the importance of genetic factors in a wide variety of conditions. Psychiatry at present is nearly all
art and very little science Under these conditions, suspension of belief, though painful for all and impossible for some, seems preferable to the enunciation of dogmas that will later have to be swept away. Fads flourish, and it is hard to maintain that the art of the physician psy-
chotherapist is superior to that of the priest, the psychologist or the charlatan. If I insist, as I do, on the importance and value of psychiatry, it is as a good and honest art of healing as against others that are crude, self-serving, and at times harmful to the patient.
Part IV: Decompartmentalizing art and science PETER BANKS, D SC, FRCP[C] I am sitting at my office desk, hurriedly eating a sandwich. Both hospitals are phoning me urgently. There is a full afternoon of appointments ahead, and then an evening meeting. There is a heap of unread journals to my right, and I am working through a pile of correspondence on my left, including two lawyers' letters and an unnecessary request from Statistics Canada for amplified information on a death certificate. Thousands of my colleagues, all across the country, are similarly attempting to do several things at once. It is the way of life of the practising doctor. The letter in my hand is from the news and features editor, asking for an article on the "Art of medicine". Suppressing the four-letter expletives, I scribble that I will try at the weekend... It is now Sunday afternoon. I am sitting in my library hoping the phone doesn't ring. My dogs are restless, willing me with their eyes to take them into the woods (for the information of the Council on Community Health, none of them has bitten a child for at least a week). I am thinking about the art of practising medicine and hoping with tempered iconoclasm that nobody expects me to make any references to Hippocrates or to Sir William Osler. No separation I am a Monist. Without going into the tortuous analogies of "Zen and the Art of Motorcycle Maintenance", I do not accept a separation of the classical and the romantic, between the science and the art of medicine. The profession is the corpus callosuin
of C.P. Snow's two cultures. Perhaps the procrastinating incompetent, sitting so uselessly in Fielding's famous picture, still exists. Perhaps, as the media tell me, the universities do harbour little cliques of soulless scientists, working in backrooms, stuffing their probes and tubes into helpless patients. It is just that I haven't met them. Most of the doctors I know work harder than most, are more intelligent than most and certainly are more patient than most. Why then the need for more on the art of medicine? Surely, little original can be written. In the index of "Familial Medical Quotations", the heading "Art of _____" is two whole columns long. If being a good doctor equates to artistry in medicine, then what is a good doctor? One who spends adequate time with his patients? In most family practices, this is impossible, and patients have consistently demonstrated that they prefer a good, fast doctor to a poor, slow one. The halflife of a good, slow doctor can be measured in months. One who keeps up-to-date? Not necessarily so. Some of the most consummate medical artists I know are years behind, but they know when to call for help, and some of the worst are constantly misusing the latest drugs and techniques. One who uses the resources of the medical team? Perhaps, but we all know the professional signposts who merely act as a highly expensive form of triage. One who can make up his mind in the tradition of "Life short, the art long, decision difficult, and opportunity fleeting"? Certainly, but preferably one who tends to be right
rather than wrong. One with a personality strong enough to influence the patients? A Sir Lancelot Spratt in every office? Heaven forbid! Obviously, the variety of personality that can succeed in the various branches of medicine is legion. One who keeps his interests broad and not just to the technology of a narrow specialty? This could be a valid criticism of modern medicine. This has always been the aim of the good doctor, and the London Hospital expresses this well in its motto, taken from the Roman poet Terence, writing in 165 BC, "Homo sum: Humani nil a me alienum puto" - "I am a man, I count nothing human indifferent to me." But how hard it is to do this, and we do need the ultraspecialist as well. I do not think the art of medicine lends itself to tidy definitions or to heavy professorial pronouncements from academia. I believe that medicine is the immensely complex interplay of one human individual attempting to help another, and that there is no single right and artistic way of doing this. It depends so much on the individual doctor and the individual patient, and that is why we like them to find each other. Common denominator If there is a necessary, common denominator, it is love. Love of one's fellow human beings, of all sorts, in all kinds of circumstances. If a doctor has not love, he is lost. It is a pity that the modern university selection board doesn't seem to recognize this. Dogs, let us go for a walk U
CMA JOURNAL/NOVEMBER 18, 1978/VOL. 119 1239
art and very little science Under these conditions, suspension of belief, though painful for all and impossible for some, seems preferable to the enunciation of dogmas that will later have to be swept away. Fads flourish, and it is hard to maintain that the art of the physician psy-
chotherapist is superior to that of the priest, the psychologist or the charlatan. If I insist, as I do, on the importance and value of psychiatry, it is as a good and honest art of healing as against others that are crude, self-serving, and at times harmful to the patient.
Part IV: Decompartmentalizing art and science PETER BANKS, D SC, FRCP[C] I am sitting at my office desk, hurriedly eating a sandwich. Both hospitals are phoning me urgently. There is a full afternoon of appointments ahead, and then an evening meeting. There is a heap of unread journals to my right, and I am working through a pile of correspondence on my left, including two lawyers' letters and an unnecessary request from Statistics Canada for amplified information on a death certificate. Thousands of my colleagues, all across the country, are similarly attempting to do several things at once. It is the way of life of the practising doctor. The letter in my hand is from the news and features editor, asking for an article on the "Art of medicine". Suppressing the four-letter expletives, I scribble that I will try at the weekend... It is now Sunday afternoon. I am sitting in my library hoping the phone doesn't ring. My dogs are restless, willing me with their eyes to take them into the woods (for the information of the Council on Community Health, none of them has bitten a child for at least a week). I am thinking about the art of practising medicine and hoping with tempered iconoclasm that nobody expects me to make any references to Hippocrates or to Sir William Osler. No separation I am a Monist. Without going into the tortuous analogies of "Zen and the Art of Motorcycle Maintenance", I do not accept a separation of the classical and the romantic, between the science and the art of medicine. The profession is the corpus callosuin
of C.P. Snow's two cultures. Perhaps the procrastinating incompetent, sitting so uselessly in Fielding's famous picture, still exists. Perhaps, as the media tell me, the universities do harbour little cliques of soulless scientists, working in backrooms, stuffing their probes and tubes into helpless patients. It is just that I haven't met them. Most of the doctors I know work harder than most, are more intelligent than most and certainly are more patient than most. Why then the need for more on the art of medicine? Surely, little original can be written. In the index of "Familial Medical Quotations", the heading "Art of _____" is two whole columns long. If being a good doctor equates to artistry in medicine, then what is a good doctor? One who spends adequate time with his patients? In most family practices, this is impossible, and patients have consistently demonstrated that they prefer a good, fast doctor to a poor, slow one. The halflife of a good, slow doctor can be measured in months. One who keeps up-to-date? Not necessarily so. Some of the most consummate medical artists I know are years behind, but they know when to call for help, and some of the worst are constantly misusing the latest drugs and techniques. One who uses the resources of the medical team? Perhaps, but we all know the professional signposts who merely act as a highly expensive form of triage. One who can make up his mind in the tradition of "Life short, the art long, decision difficult, and opportunity fleeting"? Certainly, but preferably one who tends to be right
rather than wrong. One with a personality strong enough to influence the patients? A Sir Lancelot Spratt in every office? Heaven forbid! Obviously, the variety of personality that can succeed in the various branches of medicine is legion. One who keeps his interests broad and not just to the technology of a narrow specialty? This could be a valid criticism of modern medicine. This has always been the aim of the good doctor, and the London Hospital expresses this well in its motto, taken from the Roman poet Terence, writing in 165 BC, "Homo sum: Humani nil a me alienum puto" - "I am a man, I count nothing human indifferent to me." But how hard it is to do this, and we do need the ultraspecialist as well. I do not think the art of medicine lends itself to tidy definitions or to heavy professorial pronouncements from academia. I believe that medicine is the immensely complex interplay of one human individual attempting to help another, and that there is no single right and artistic way of doing this. It depends so much on the individual doctor and the individual patient, and that is why we like them to find each other. Common denominator If there is a necessary, common denominator, it is love. Love of one's fellow human beings, of all sorts, in all kinds of circumstances. If a doctor has not love, he is lost. It is a pity that the modern university selection board doesn't seem to recognize this. Dogs, let us go for a walk U
CMA JOURNAL/NOVEMBER 18, 1978/VOL. 119 1239
