Science and art, patient and problem

I used to think of medicine as a dichotomy: the hard sciences making up the backbone, with the social art of treating patients being the fun part. Then an emergency furthered my appreciation of this relationship.

I always recognized the importance of both the science and the art of medicine, but it took a personal experience to make me truly appreciate just how tightly the two are intertwined.

I used to think of medicine as a dichotomy: the hard sciences making up the backbone, with the social art of treating patients being the fun part—the icing on the cake, perhaps. Some years ago, however, I found myself in an emergency medical situation that furthered my appreciation of this wedded relationship.

Courtesy of Mr Nahvi
Courtesy of Mr. Nahvi.

I had an intestinal intussusception—my guts bungled up inside themselves, cutting off their own blood supply and slowly necrosing—but I didn't know it at the time. I walked to a local clinic and presented with abdominal pain. The physician I saw was concerned enough to direct me to the nearest emergency department for further workup. But, unconvinced of the situation's urgency, I refused to go. Not because I was ignorant or because I didn't trust the doctor: I refused because I was 21 years old and, coming from a working-class family, had lived much of my life without health insurance. I was afraid of the cost of the ambulance, and abdominal pain that might turn out to be nothing serious wasn't enough to get me to risk that exorbitant cost.

It would have been easy for the doctor treating me to quit at this point. He had outlined the risks, I understood them, and yet I refused his advice, which was my right. It would have been easy for him to get frustrated; having done his job methodically and thoroughly, he could have taken the stance that anything that resulted from my ignoring his advice would be my own burden.

But this physician made no distinction between treating my condition and treating me as a person. He continued to probe. He asked why I didn't want to take the ambulance, and what my concerns were. Understanding the problem was financial, he negotiated with me, thought outside the box and figured out a solution. There was a car that came by once a day to transport lab specimens from the clinic to the hospital. He spoke with the driver, who agreed to take me along. When I got to the emergency department the intussusception was identified and an emergency surgery was performed. The lack of significant delay potentially saved my life.

The doctor's actions struck me as exceedingly kind at the time, but I only began to realize the significance of what he did years later, as I went through medical school. In addition to all its other challenges, medicine requires one to walk a fine line between taking a rigid approach to a patient's disease and a flexible one to the patient himself. The best treatment for a patient's disease may be entirely different from the best treatment for the patient as a person. In other words, taking the ambulance may have been the best thing for me to do for my intussusception, but my doctor's jury-rigged solution was the best treatment for me as a person. It was what I was willing to do, and it was what allowed the situation to end well.

I've found that one of the greatest challenges and greatest joys of health care is walking that fine line, integrating the art and the science of medicine. Adeptly combining scientific rigidity with social flexibility and understanding, that doctor not only saved my life, but also taught me how to provide good medicine, setting a powerful example for my career.