Art, Science and Charity in Medicine

Sir William Osler spoke of the influence of these three forces on the life and conduct of a physician. He eloquently used temperature analogies to characterize the necessary qualities of a physician – burning hot or keeping cool, but never being lukewarm:

”….of Art, the highest development of which can only come with that sustaining love for ideals which burns bright…”;

 “Science, the cold logic that keeps the mind independent and free from the toils of self-deception and half-knowledge”;

“of Charity, in which we of the medical profession, to walk worthily, must live and move and have our being.”

                                      (Aequanimitas, 1904)

Today’s medicine tends to be more tepid, at least in my field, Primary Care. Others clamor to set our priorities, to the point that doctor and patient sometimes both feel marginalized. The personal doctor-patient relationship is sometimes replaced by a more generic consumer-provider exchange, where a patient may see the physician as just a necessary intermediary between their need and the solution they already know they want – as in the case of asking for a drug advertised on television.

We must start with what Osler calls “the cold logic of Science”. It is our role and our duty as physicians to view new claims of clinical benefit from tests, procedures or pharmaceuticals with a critical mind, applying our training and experience. Simply following guidelines is an abdication from our professional responsibility. You don’t need to go to medical school to follow guidelines – in fact, it may make it harder sometimes.

The burning flame behind our passion for the Art and compassion for our fellow human beings, what Osler calls Charity, must never be lukewarm.

We all have to work at the Art of medicine. It is easy to slip into routines of complacency; another case of this or that, giving it our usual “Spiel”. Seeing each patient and each clinical presentation as unique is necessary in order to connect with the other person in the exam room. Finding the right way to approach each one of many seemingly similar case histories is what makes a personal physician just that – each patient needs something slightly different from us. The better we understand those needs, the more effective we can be.

The Art of the medical practitioner lies in the balance between cold science and hot passion. This is where the chemistry between physician, patient and disease takes place.

Call it chemistry, even alchemy: As physicians, we are catalysts in each patient’s transformation. And just as any other catalyst, we cause a chemical reaction to take place without being consumed ourselves in the process.

Our true challenge as physicians in today’s health care climate is keeping the flame Osler spoke of. Without that flame we are at risk for straying from the ideals behind our profession.

Osler warned us never to feel lukewarm about being doctors:

“By far the most dangerous foe we have to fight is apathy – indifference from whatever cause, not from a lack of knowledge, but from carelessness, from absorption in other pursuits, from a contempt bred of self satisfaction.”

1 Response to “Art, Science and Charity in Medicine”

  1. 1 Jewell Burke April 30, 2012 at 2:35 pm

    I do believe Osler’s warning could apply to most of us from housewife to President as well!

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Osler said “Listen to your patient, he is telling you the diagnosis”. Duvefelt says “Listen to your patient, he is telling you what kind of doctor he needs you to be”.


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