Is Medicine an Art?

My son was required to write a paper about the difference between an art and a craft. We talked about the subject and the phrase, “the art of medicine”, came to my mind. It is a statement that is commonly expressed in the medical community. After we chatted about it and I gave my opinion, he wrote his paper. When he explained in his paper that certain activities, like sports or medicine, could be considered an art. It was not received well by the instructor and these activities were deemed as crafts. So, it made me reflect on the phase, “the art of medicine”, and really consider if this saying was accurate.

By strict definition, what is an art or a craft? An art is defined as “the quality, production, expression, or realm, according to aesthetic principles, of what is beautiful, appealing, or of more than ordinary significance.” A craft is defined as “an art, trade, or occupation requiring special skill, especially manual skill.” While I pondered these definitions, it really made me reflect on my prior experiences in the field of healthcare that reinforced the phrase, “the art of medicine”.

In pediatric critical care medicine, there are definitely a lot of aspects that require special skill and training. While the foundation of decisions is mostly fashioned by education from textbooks, lectures, and observation, one could not attribute all outcomes solely to these learning methods. The skills of pediatric critical care medicine fall under the heading of a craft, but I experienced instances in my career where clinicians showed something unique.

• I was caring for a child with significant heart failure as a result of chemotherapy treatment for cancer, she was on a significant amount of medications to try and keep the heart functioning as close to normal as possible. However, we were losing the battle and escalating support was required without any perceived benefit. I was a trainee at the time and my attending physician came to the bedside to review what had been done. With an exclamation of certainty, he said, “stop everything!” I was baffled. How were we to just stop these life-saving medications? Was he crazy? Did he know something that everyone else didn’t? Well, we ended up stopping the medications and the child’s clinical condition improved. Her heart was still not functioning well, but she was doing better without the medications than with them.

• In a similar fashion, another attending physician instructed me to intubate a baby that he had passed by on rounds (put a breathing tube in the trachea to support breathing and heart function). The infant had a heart defect and recently had heart surgery. By my evaluation, the infant appeared stable. I did not question my attending’s decision, but the medical team did wonder if it was a little unnecessary. I intubated the infant without issues. About 2-3 hours later, the infant started to clinically deteriorate and if we did not intubate the infant when we did, he would have certainly been in more of a life-threatening situation without having the airway secured. How did the attending physician know?

• Finally, our team received a devastating call from an outside emergency room to request the transfer of a child who was thought to be brain dead. When someone is considered brain dead, their brain function has ceased from some event that starved the brain tissue of oxygen and the cells died. If the brain is dead, the individual is officially considered deceased, despite a beating heart. Well, our physician accepted the patient. Why did we just accept a dead patient to care for in our pediatric ICU? Well, the statement that followed really shocked me at the time. She said that, “we can provide a good death.” Being able to give a family closure to a catastrophic event and loss of a child takes a special kind of compassion and understanding for which this individual and supportive team was exceptionally suited. I still hear the ringing of those words in my mind.

These events really resonated with me and showed me a practice of medicine that transcended any learned skill.

So, I return to question if, “the art of medicine”, is accurate. The experiences that stand out in my mind are not taught in school or written about in textbooks. These outcomes were based on not only studying and learning by experience, but also the individual who was making the decisions. Given the same situations, others may not have made the same choices and had different outcomes. There was something beautiful, appealing, and of more than ordinary significance about the events that I described. As I have progressed in my career, I have only reflected upon them with more appreciation and reverence about what they represent. Medicine is more than just a skill. In its highest form, medicine is truly an art.

Do you feel that medicine is more of a craft, art, or both?  Please feel free to comment in the comment section!