Anyone entering medical training is taught that Medicine is an Art, one that combines scientific knowledge, discovery and application with its practice. It is both art and applied science. It should never become nor has it ever been only all one or the other. To be Medicine at all, the noble vocation that so many brilliant minds sacrifice to pursue in service to their fellow humans, the practice must balance art with evidence and standard practice. Therefore, those who practice Medicine are indeed artists in addition to scientists. To embrace only one side of medicine as a practitioner is folly. It inevitably leads to either poor physical care or poor emotional care. Humans are a mix of the physical and emotional. Treating patients means recognizing this balance and it’s inexorable relationship to caring for the entirety of a human being.
We physicians know this, and yet seem to have little control over the unfortunate direction our profession is headed in extinguishing the Art of it. For Medicine to reclaim its soul and practitioners to find their purpose again, we need to remind practitioners of their Artistic side. The online Oxford dictionary defines Art as “the expression or application of human creative skill and imagination.” Creativity is essential to an Art-form. However, when creativity is not only stifled but also discouraged fervently, art dies.
For Creativity to flourish, individuals need time to let their minds wander. They need time away from prototypical tasks and regulations to allow their imaginations to take hold. No great doctor ever made a difficult diagnosis because they only looked at the number data presented to them without taking into account the patient’s lived experience. It takes imagination to care for a human, both in solving a diagnosis and trying a treatment regimen. The art of healing and caring for someone requires that we listen to our patients stories and have the capacity within ourselves to imagine what their experience might be like. It requires empathy, which is preceded by imagination and creativity. Yet what are we to do in this current healthcare environment? How can anyone be creative when they are solely compensated based on if they proved they followed the protocol by clicking the necessary data checkpoints in the Electronic Medical Record and then did it all over again for as many patients as possible in their shift.
I have now heard many stories of patients frustrated with their physicians. Persons with physical symptoms but whose physicians were unable to see anything but the numbers and data in lab work when considering a diagnosis. Where are the physicians who are allowed to be creative and think outside the box for the benefit of the patient? I know a few, but the numbers seem to dwindle daily. To be a decent Geriatrician, one can never forget the artistic side because frankly we have no evidence base or protocols for our aged population. Truly, no two 85 year olds are alike. There are some consistent patterns but also individual nuances that complicate caring for any one elderly person. I’ve always had to balance art and science and enjoyed both aspects. And I have burned out when in employed positions where I am forced to comply with data entry, high volume turnover, meaningless regulations, and the sense that none of the forced menial tasks do anything for my patient. Essentially when I have not been given the time necessary to listen to my patients, to collect necessary data but also look at the bigger picture, to think creatively within the context of the individual I’m helping, to develop a relationship, and to formulate a plan and then try it out, I know I am not practicing my art. And without the art, what is the difference between a physician and a machine?
Perhaps it is too late, and Medicine has already lost its soul to data, protocols and the grind of a redundant, purely scientific and unemotional patient-mill approach to health. We doctors might as well be robots. When thousands of patients are rejecting traditional medicine and properly trained physicians for chiropractors, natural-paths, and advice from the ilk of anti-vaxers and Gwyneth Paltrow’s GOOP, we must ask ourselves if some of it wasn’t self-created. How can there be art in rote q 10 minute office visits? Where is the creativity in narrating a person’s story and exploring various differentials in the medical notes anymore? Click boxes, data extraction and ICD-10 codes have eliminated room for consideration of differential diagnoses or explaining one’s clinical thought process. One can not clearly dictate a thought process into Siri without constant interruption by typos, and transcriptionists have ceased to exist. We no longer get down time with our healthcare colleagues on shifts to form working relationships. And we certainly are not allowed the necessary freedom to triage our time with the patients who need it most.
Honestly at this point I’m not sure where this is headed other than my own personal self-realization that if medicine has already lost its soul, then I need to find a new way to be creative and practice my art of caring and healing people. I hope and pray that’s not the case for the sake of Medicine. But maybe the Medicine I bled time, relationships and money for is already lost forever? Maybe I’m too nostalgic? Certainly me blogging my feelings are not tipping the balance back towards the ideal of Medical Practice of nearly equal parts art and scientific application. What’s next for me as an M.D., something so ingrained into my identity? I don’t know……but I’m certainly open to help and ideas. I suppose I turned out to be many parents’ worst fear: an intelligent artist with a heart of gold and creativity to boot who spent hundreds of thousands of dollars on an education but finished with no concrete way to make a living with their art. I’m ok with that though. It’s better than becoming a robot.