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The practice of medicine is not a science.  It is an art, based on science.

A good diagnosis is based on synthesizing converging lines of evidence, each with its own probability as opposed to strict deductive reasoning.  One important  technique in taking a patient history is realizing their psychological state at the moment.  For example, in my field of Cardiology, I must often evaluate  complaints of chest pain.  Now we understand that  the science of Coronary Blood Flow and the effect of blockages of blood flow, due to hardening of the arteries very well.  However, the nature of gravity of the patient’s complaint is very important.

If a patient states in great anguish, “Oh doctor, this chest pain is the worst of any kind of pain I’ve ever had.  It goes on for hours, wakes me up at night and seems impossible to relieve.  Am I going to die?”    It is not uncommon for such a history to be delivered inthe presence of a spouse or parent.

Now such a patient probably does not have heart disease- although some testing may be indicated.  It is much more likely that the source of the discomfort is an anxiety state and that the patient is unconsciously seeking attention and secondary gain.

Conversely, if a patient tells me, “Its not a pain, exactly… Its more like – I don’t know – a pressure, ache, or burning… and it only occurs if I exert myself or am upset about something.  Also, if I stop what I’m doing or calm down, it goes away!

Such a patient will then look at me as if to further say, “So that means it’s not serious, right?”

On the contrary, this patient probably does have heart disease.  His minimizing symptoms and denying the severity or frequency of the pain, indicates that he  does not want to be sick!”

Thus medicine is a combination of the scientific and humanistic disciplines and both aspects must always be kept in mind.


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