Ask Dr. Ira Williams

Idealistic Rhetoric

In last week’s post, Finding the Art of Medicine, Dr. Audiey Kao, AMA Vice-President, Ethics Standards is quoted as saying, “I would argue that this logic applies to the art of medicine - otherwise it simply becomes idealistic rhetoric.”

Idealistic rhetoric are prophetic words regarding the medical profession’s inability to measure the quality of clinical medicine. The volume of medical literature attempting to identify and judge the quality of medicine is enormous, and the wide range of sources of that literature is immense. Research papers by governmental departments, agencies and organizations, universities, public and private organizations and books by doctors, lawyers and other academic experts contribute to a gigantic amount of words on paper, and therein lies the problem.

If only it was possible to collect all of the current literature regarding medical malpractice and place that collection under great pressure, with the desired goal to extract the essence. I challenge anyone to read the books, articles and research papers regarding the cause and/or the cure for the medical malpractice crisis and catalog any definitive measures offered as a potential solution for that crisis.

Idealistic rhetoric abounds in all of the literature regarding medical malpractice and medical peer review, while the essence of a possible solution remains undiscovered.

The truth regarding all medical treatment is a simple as the formula for water. Mix two hydrogen molecules with one oxygen molecule and the result is water. Every basic form of medical care can be calculated in a similar manner. All medical care is comprised of the science and the art of medicine, and when combined in specific patient care the result is a medical standard of care. That basic equation applies to every form of patient care from a tonsillectomy to a heart transplant.

Doctors are taught the science of medicine and each doctor applies their personal art of medicine each and every time they treat a patient. One should surmise, “It can’t get much simpler than that, can it?”

Yet, almost sixty years after the “Dawn of Modern Medicine” Organized Medicine continues to lament their inability to identify, define and judge one of the two basic characteristics of every form of medical care. Doubters should search the web for the “art” of medicine and limit their findings to that form of art, which, combined with science, yields a medical standard of care. Their findings will be bleak.

Some might attempt to defend this hugh professional lapse by comparing efforts to describe the art of medicine with similar efforts to describe the taste of a fine wine or a delectable dessert. Not true! The art of medicine is a tangible characteristic evident in every incident of patient care.

It doesn’t take long for an air force or airline crew member to distinguish the “art” of flying demonstrated by various pilots. There are great pilots, good pilots and “good-luck” pilots and the same analogy exists within the medical profession. The distinction between the separate groups is exhibited through each individual practitioner’s art of medicine.

Still, Organized Medicine decries their inability to even identify that salient characteristic, much less define and judge it. Definitive discourse must replace idealistic rhetoric regarding the basic characteristic of all medical care, else the present chaos will continue to inflict pain upon our heirs.

Great reviews for my first book: First, Do No Harm

“…a fascinating read for anyone working in healthcare. He offers an alternative to the historic handling of medical malpractice and truly believes that the public’s trust in the medical profession can be resurrected.” Nancy Herbein RN, CNOR - AORN Journal

“First, Do No Harm is a riveting revelation of a severe social problem. First, Do No Harm goes beyond pointing out the injury, however it offers viable strategies for inproving national health care.” The Bookwatch, The Midwest Book Review

“One of the largely ignored findings of the Harvard Medical Malpractice Study is that, although most physicians who responded to a survey were willing to admit that all doctors make mistakes, they are often unwilling to label substandard care the result of negligence. First, Do No Harm confronts this view head on and proposes a way to start thinking seriously about how to reduce medical errors and maybe even the amount of malpractice litigation.” Neil Vidmar Ph. D. Duke University Law School - New England Journal of Medicine

The perfect analogy for the practice of medicine is a pilot flying a single engine airplane. Each student pilot is taught the science of flying an airplane. Each pilot, student or graduate pilot, provides their personal art of flying an airplane each time they take off and hopefully land safely. The exact same combination of science and art occurs each and every time a doctor treats a patient.

All medical care has three inherent characteristics: science, art and a standard of care.

Science of Medicine: Doctors are taught the science of medicine. Medical schools transform non-doctors into doctors. Other than rare exceptions, all current medical care has a basis derived from previous forms of medical care.
Art of Medicine: The art of medicine does now and has always existed. Every doctor provides their personal art to each patient they treat.

From a tonsillectomy to a heart transplant, each patient is like a painter’s fresh canvas, where the doctors practice their art of medicine. But, no doctor can tell you exactly what it is, or how to find and judge it.

Though the medical profession has failed to establish a means of identifying, defining and judging one of the two inherent characteristics of all medical care, it does not mean the art of medicine is intangible nor identifiable and capable of being judged.

Dr. Audiey Kao, AMA Vice-President, Ethics Standards said in 2002, “A not-so-famous man once said, ‘If you can’t measure it, it’s less likely to be important.’ In the case of good medicine, it is widely accepted that we need to measure how well physicians are providing clinical care so that we can continue to make improvements. I would argue that this logic applies not only to the science of medicine, but also in many important respects to the art of medicine - otherwise it simply becomes idealistic rhetoric. Leaders in medicine must work together to develop effective ways of imparting and evaluating the ethical skills and competencies of physicians.”

Organized Medicine’s lack of ability to identify, define and judge is one of the two missing links in the medical malpractice crisis.