Art of Medicine

The practice of clinical medicine as an art and as a science. J Saunders. J Med Ethics: Medical Humanities 2000;26:18-22.

In this paper, John Saunders describes how each patient needs to be treated under particular circumstances by applying art to the practice of medicine. Aside from the difficulties in taking an evidence based approach to assigning quantitative risks and benefits, J Saunders suggests that the physician should ask the following questions from him/herself and communicate openly with the patient before making decisions about diagnostic tests or treatment:

1. How much should I trust the available information?
2. Would knowing the results of a diagnostic test make a difference, and if so to whom?
3. What risks are worth taking?
4. What approach would be most helpful to the patient?
5. Is the physician competent and respectful?
6. To what extent is the patient’s desire for testing biased by her fears, depression, or incomplete understanding of the illness, tests or treatment?
7. Is the patient responding to the situation in a way concordant with his/her previous actions and values?
8. What values and biases affect the way the physician frame the situation for his/herself and for the patient?
9. How can the physician tolerate uncertainty and risks associated with the medical knowledge available about the diagnostic tests or treatments?