FEATURE
Anna Downs
In the first few years of medical school, we are taught that medicine is a science. Sure, there are always the passing references to the“ art of medicine,” but we are ultimately tested on principles grounded in published proof and decades( centuries) of data. As a student, this collection of knowledge is both intimidating in its scope and reassuring in its proven veracity and effectiveness. During my externship, I learned to look up practice guidelines, applicable case studies, and other evidence-based resources to understand the clinical decision- making of the physicians I had the pleasure to learn from. I found it heartening to know that even the most seasoned physicians have to look up treatment guidelines and seek the counsel of other physicians on a daily basis. Thankfully, there is a( scientifically-proven) method to the madness.
Despite this strict adherence to scientific evidence, I found that in medicine, as opposed to other scientific disciplines, there was a strong element of the elusive“ clinical intuition” that had been referenced during my first year of medical school. Was this the“ art of medicine” that I had heard so much about? Medicine seems to consist of many generalizations that must be applicable to many different patients, even though each case is unique. How were these physicians classifying one meningitis patient as“ textbook” and the other case as“ tricky?”
I began to see that, while much of this intuition is based in fact that becomes second nature, there are aspects to treatment that come from the human interaction between the doctor and patient( and in Pediatrics, the parent). I saw that observing the child’ s behavior could be just as helpful in determining“ sick” vs.“ well” as a physical exam. Physicians talked about a“ feeling” they had that the current course of treatment was correct, or that the patient was on the mend. I even found myself forming such judgments during my short time in the hospital( which I certainly kept to myself). For a student with little clinical experience, the externship challenged me to think about medical science and art not as two opposing forces, but as complementary entities. I am not the first to comment on such a realization, nor will I be the last, but as a medical student in first bloom, it excited me to know that abandoning my former dreams of studying the humanities did not mean that I was fully giving up the arts.
One of the attending physicians that I met described this balance to me in a way that made things quite clear( even if it proved that he might be a polymath). In physics, he said, scientists were able to predict the presence of the Higgs boson particle using standard particle physics models over 60 years ago, even though there was no tangible proof. It was not until recently that the Higgs boson was discovered, but it fit into the predicted model beautifully. Yet in medicine, he continued, science will never be this exact, and you must accept that reality. I will never be able to predict just how a patient will progress or what variables might alter the equation, but this externship and its accompanying realizations have provided me with a starting point for how I hope to approach clinical practice, with thoughtfulness and professionalism.
Brandon Mudd, Dillon Stanfield and Anna Downs are currently 2 nd year medical students at the University of Louisville.
22 LOUISVILLE MEDICINE