Address for Correspondence:
Dr. Prof N J Mani MS (Orth), M.Ch (Orth), Chief of Orthopaedic
Department, Baby Memorial Hospital, Kozhikode, Kerala, India.
PIN: 673004. Email: orthobmh@gmail.com
Over the last three decades, I have witnessed bewildering
progress in medical science. While some diseases have
been eradicated, others have cropped up, or remained as they
have for ages. Scientific discoveries, innovations and genomic
medicine have transformed the way we approach a patient. From
the moment a patient enters a hospital he is subjected
to a spectrum of technological studies including scopies, to
peer within the human body, to visualize nature's beauty,
hitherto hidden to the naked eye. In spite of all these
advancements the patient is very often left in despair and
confusion. He craves for the personal touch and a heart to
heart talk with his doctor. Modern day medicine with all its
glorious superlatives has left a wrinkle in our confidence. A
fundamental question remains unanswered. Is medicine an art or
a science?
What is scientifically "True and Correct" today may not be
relevant tomorrow. Dogmas change and approaches to disease
management swing from one end to the other. In the fifties, an
atom was considered the most indivisible form of matter; there
can be nothing far from the truth these days!
In Orthopaedic practice, the concepts of healing of a fracture
is a case in point. In the sixties, when I started my career,
fracture healing was thought to be perfect with "natural
healing with callus formation". In the eighties, I preached
and practiced anatomical reduction and surgical fixation.
Healing without a callus became the end point to ensure bone
healing with normal function. Now the wheel has turned a full
circle to revert to callus formation and the accent is on
maintaining length, alignment and rotation.
These experiences make me think of patient care in a whole new
dimension - a combination of fluidity, complexity and
dynamism. Healing is a by-product of the patient-physician
relationship as much as it is due to the complex medical
parameters that govern the series of events that start with
disease and end with cure, morbidity or mortality.
A protocol based and algorithmic approach, chasing shadows,
perusing lab data and above all paucity of time have estranged
the patient - doctor relationship. Decisions are made by us in
cozy cold, closed chambers very often without the patient in
view. We deliberate inside, while the anxious patient waits
outside and sends a prayer to the Almighty, hoping for the
right decision to be made. The ritualistic methods of history
taking, clinical examination, developing a working clinical
diagnosis and finally deliberation and contemplation have
become a relic of the past. They have been sacrificed on the
altar of evidence based scientific medicine!
The sanctity and intimacy of physical examination legitimate
the human connection and this is most powerfully mediated
through touch. Touch is a primal and potent act, beyond skin
to skin contact, and engages in the emotional domain called
praxis. If we apply Newton's third law, touch is always
reciprocal!! Touch has an affective dimension to care, the
power of which extends beyond words. The power of laying hands
in healing was known since the time of Asclepius, the
legendary Greek god. The Bible reminds us that those who
touched Jesus and those who were touched by Him were healed.
Nowadays, touch has gained a different connotation. In today's
era of marketing and gimmickry - it is a word that encompasses
only the jargon - "Stay-in-touch-marketing".
It is in this context that the motto of BMH "Committed to
care" gains significance. It sends across a message of
assurance to the patient that we are available to them at all
times, and that we stand fully committed to stand with them,
through thick and thin! We wish to emanate empathy from our
dealings with patients. Communication - both verbal and non
verbal is crucial to the success of this motto. Any dilution
of this standard, puts us at discomfort and the risk of even
litigation.
While we surge forward into the modern era of medicine, we
need to clarify to ourselves that medicine is an art based on
science. It cannot be practiced as an inanimate, heartless,
scientific exercise. The utilization of the five senses along
with the effective integration of cerebral faculties makes it
the perfect recipe for a successful patient - doctor
relationship and thereby satisfactory patient outcomes. The
quest is short if we realize that the practice of medicine is
an art that is played on the solid stage called science.
The sight of a new born baby is a marvel and a mystery. But
isn't the mystery of creation the true source of all art and
science? Albert Einstein, the great scientist and philosopher
once said "The most beautiful thing we can experience is the
Mysterious. He to whom the emotion is stranger, who can no
longer pause to wonder and stand wrapped in awe is as good as
dead - his eyes are closed. The insight into the mystery of
life, coupled though it be with fear, has given rise to
science as it has to religion".
May I ask -- Modern Medicine, Quo vadis ?