Once, I agreed to be an expert witness. Never again! Not because I was grilled on the witness stand for several hours. Not because my qualifications were questioned. And certainly not because I was compensated poorly for my time. Rather, I don’t ever want to have to defend our profession’s great tradition steeped in the “art” of medicine.
A little over a decade ago, I was hired on behalf of a patient’s attorney who was suing an insurance company for “bad faith” decision-making for denying the patient what I and other physicians believed was medically necessary treatment. The lawyer representing the insurance company confronted me on the stand. “Dr. Lazarus,” he belted out, “are you familiar with this textbook?”
“The Art of Medicine” is a phrase I’ve never forgotten after reading Viktor Frankl’s Man’s Search For Meaning. Frankl and other physicians at Auschwitz concentration camp quickly learned that the information contained in medical textbooks was irrelevant to their plight, i.e., the brutal conditions their bodies and minds were required to endure.
Who could have predicted the need for treatments for the myriad illnesses resulting from the unimaginable inhumanity prisoners were subjected to? And conversely, no medical textbooks of that era anticipated the surprising resiliency of some prisoners in the face of famine, torture, and disease. “Resiliency” wasn’t even a concept in the early to mid-1940s.
As someone who embraced and practiced evidenced-based medicine long before the term was coined, testifying about the sanctity of the art of medicine was an interesting turn of events because I had to find it within myself to tell the lawyer how compassion and caring should have factored into the insurance company’s decision. I had to channel Viktor Frankl.
My opening pitch involved telling the insurance company’s lawyer that there’s much more to practice than what textbooks and journal articles teach us. To practice the art of medicine means that you know your patients inside-out, including social and psychological issues impacting their health.
When you’re a psychiatrist, you know them even more deeply. Who do they love? Who do they argue with? Who do they hold a grudge against and regret not making amends? Textbooks and journal articles do not steer you in that direction, I said to the attorney.
The art of medicine goes beyond mere knowledge obtained from double-blinded placebo-controlled studies, I continued. It requires treating the patient as a whole person, not just their illness. This includes taking into consideration their mental and emotional health, lifestyle, and personal circumstances. It demands treating patients with empathy and concern.
Understanding and acknowledging a patient’s feelings can greatly improve their healthcare experience and can positively influence their health outcomes. Doctors have to discover the essence of their patients’ existence on their own and not through some textbook, I concluded.
The insurance company doctors who denied care to this patient knew nothing about him other than that he had condition “X” and his physician was requesting treatment “Y,” which the insurance doctors considered “not medically necessary.” They did not even weigh the fact that, despite the patient’s current therapy, he was not responding to it and was becoming progressively blind.
Such callous decision making and patient neglect, I argued, was tantamount to practicing medicine in bad faith. My argument was a stretch because legally “bad faith” generally refers to intentional dishonest behavior or misleading actions that result in harm or potential harm, and that was not entirely evident here since the insurance company physicians were simply relying on a set of guidelines, misguided though they were. Nevertheless, the judge was sympathetic and he essentially forced the insurance company into a settlement.
The Balancing Act
The art of medicine and the science of medicine are two fundamental aspects of healthcare. They represent different but complementary approaches to patient care. The science of medicine aims to provide objective, evidence-based solutions to health problems. It provides the tools and knowledge necessary to diagnose and treat diseases.
The art of medicine, on the other hand, refers to the more subjective and personal aspect of healthcare. It involves understanding the patient as an individual, empathizing with their experiences, and building a therapeutic relationship. The art of medicine ensures that broad knowledge of the patient is applied in a compassionate and culturally competent manner. Both the art and science of medicine are necessary for effective medical practice.
I don’t have anything against lawyers. I just wish more of them would read Man’s Search For Meaning. This book could help them understand the importance of empathy and compassion in the pursuit of justice. It could help them recognize the limitations of relying solely on textbooks and guidelines, and encourage them to see the value in embracing the art of medicine.
The art of medicine should not be overshadowed by the science of medicine. While evidence-based practice is important, it is equally essential to acknowledge the individuality of each patient and consider their unique circumstances. The delicate balance between the art and science of medicine is what truly allows healthcare professionals to provide comprehensive and compassionate care. Let us keep the flame of the art of medicine alive, for the sake of our patients and the integrity of our profession.