Rapid Responses to:

EDITOR'S CHOICE: Richard Smith From publication to change BMJ 2003; 327: 0-h [Full text]

Rapid Responses: Submit a response to this article

Rapid Responses published:

The Science and the Art of Medicine

BM Hegde   (6 July 2003)

The Science and the Art of Medicine 6 July 2003
BM Hegde, Vice Chancellor, MANIPAL-576 119. INDIA Send response to journal: Re: The Science and the Art of Medicine	Dear Sir, Learning experiences for doctors of the evidence produced by the science of medicine versus its bedside application are not easily accessible within clear cut black and white areas in the present medical wisdom. The huge grey area is widening by the hour. The "so-called" science of medicine, that we swear by, is only reductionist. The body, however, works as a whole. The twain rarely meet, resulting in each new input adding to the existing burden for the clinician on the bedside. To cap it, there is the publication bias for positive results in preference to the negative data. Most reductionist scientific data in the medical claptrap get altered on long term audits. This is understandable since time evolution in the affairs of mankind does not depend on reductionist calculations. Thinking doctors then have the conflict between the data that their teachers and the journals put out and the real life happenings on the bedside. Under the circumstances CMEs do not contribute much to continuing personality development(CPD). Experience is NOT WHAT HAPPENS TO ANYONE, BUT EXPERIENCE IS WHAT ANYONE DOES WITH WHAT HAPPENS TO HIM/HER. When a doctor uses his/her thinking capacity, he/she is bound to get confused. To quote an example, there are six guidelines for hypertension management and more are being added daily. If one computes all of them together, the inclusion criteria cater to a meagre 39% of patients. The majority (61%) does not fit into any of the guidelines. What should a clinician do under those circumstances? Would someone address these questions in the near future in some fast tracked papers to make medicine less evidence burdened and more evidence based, please? Any idea that is holistic is rejected in the present set up. May be most of our "thought leaders" feel uncomfortable with what they do not (do not want to) know! The above mentioned doctors' dilemmas are not confined to isolated areas of clinical practice. They are widespread and could even be universal. yours ever, bmhegde. Competing interests:   None declared