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