Intended for healthcare professionals

Observations Body/Building

What doctors have in common with architects—part 1: A manual art

BMJ 2015; 350 doi: (Published 07 April 2015) Cite this as: BMJ 2015;350:h1810
  1. David Loxterkamp, medical director, Seaport Community Health Center, Belfast, Maine,
  2. Bruce Snider, architect and writer on US residential architecture
  1. david.loxterkamp{at}

In the first part of a two part dialogue on medicine and architecture, David Loxterkamp and Bruce Snider reflect on the effects of rapid change on each profession and the importance of separating essence from ornament

Have we lost touch?

DL: Medicine and architecture belong to the physical arts. Their basic units of measure—bodies and buildings—make a sturdy and recognizable impression as you stand before them. But the old standards are changing. Recent developments in genomics, population health, patient centered care, and information technology, such as electronic health records, have changed the way medicine intersects with society. Doctors increasingly work in a virtual environment where touch is relegated to technicians who treat by following doctors’ orders. It is reminiscent of professional etiquette in the 18th century when, as Paul Starr noted, “physicians, as gentlemen, declined to work with their hands; they observed, speculated, and prescribed. Manual tasks were left to the surgeons, who until 1745 belonged to the same guild as barbers.”1

BS: Architects too ply their trade increasingly in a virtual realm. When I began my career in the early 1980s my colleagues and I worked at long drafting tables, sitting on tall stools or standing. The radio played classical music, and we …

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