Science, humanism, and the nature of medical practice: a phenomenological view.

Abstract

PERSPECTIVES IN BIOLOGY AND MEDICINE Volume 28 ¦ Number 3 ¦ Spring 1985 SCIENCE, HUMANISM, AND THE NATURE OF MEDICAL PRACTICE: A PHENOMENOLOGICAL VIEW MICHAEL ALAN SCHWARTZ* and OSBORNE WIGGINSt A compelling paradox confronts present-day medicine. Major advances in medical technology are proclaimed almost daily. Built on this flourishing technology are equally significant gains in the physician's ability to understand the mechanisms of illness, devise new treatments, prolong life, and cure disease more often. Inexplicably, dissatisfaction with medicine grows despite this real progress. Many patients dread medical technology and feel a deepening sense of alienation from their physicians. Patients tend to view doctors more as remote technicians than as healers. The technology is experienced as invasive and dehumanizing . As a result, patients frequently fail to accept their doctor's recommendations or to comply with treatment regimes. Even in the face of the solidly documented efficacy of orthodox treatments, patients turn to unorthodox medical practices, perhaps in increasing numbers. Dissatisfaction is also apparent on the physicians' side. Doctors seem unable to practice humanistic medicine in the face of the intensified demands of medical technology. The explosive growth of medical knowledge entails an increasing specialization wherein no single physician remains competent to care for the overall needs of a patient. Furthermore , the burgeoning cost of the technology renders medical care so expensive that taking the time to talk to the patient seems an archaic luxury. Although more and more physicians recognize the need for *Department of Psychiatry, St. Vincent's Hospital and Medical Center of New York, New York Medical College, 203 West 12th Street, New York, New York 10011. !Department of Philosophy, New School for Social Research, 65 Fifth Avenue, New York, New York 10003.© 1985 by The University of Chicago. All rights reserved. 003 1 -5982/85/2803-0439$0 1 .00 Perspectives in Biology and Medicine 28, 3 ¦ Spring 1985 | 331 attending to the social and psychological roots of health and illness, they also find it quite difficult to integrate these psychosocial components into their actual practice. The task of integrating medical science and medical humanism thus becomes urgent. Attempts at such integration abound. Across the country the majority of medical schools have programs that focus on human and ethical concerns [I]. Liaison psychiatrists increasingly round with other physicians in order to stress the psychological, social, and humanistic dimensions of health care at the bedside. Admitting committees at medical schools are more sympathetic to candidates with a background in the humanities. At the conclusion of training, more attention is now devoted to the physician's humanistic attributes. For example, the American Board of Internal Medicine has recently required "high standards of humanistic behavior in the professional lives of every certifiable candidate" [2]. Despite these recent initiatives, an ongoing 3-year review of the education of student doctors by the Association of American Medical Colleges continues to uncover an inadequate emphasis on humanism in medical schools [1, 3]. Integrated efforts such as the ones mentioned above, laudable though they may be, prove inadequate because they merely graft a kind of remedial humanism onto a fundamentally technological and biomedical practice. Ifthe root disciplines of medicine remain natural sciences, such as biochemistry^ physics, and physiology, we might wonder how the addition of humanistic approaches would substantially change medical practice. This task of integrating humanism into medical science is rendered even more puzzling when we realize that "humanism" remains an ambiguous term. It can refer to some "art of medicine," to ethical values, or to human sciences, such as psychology and sociology. Do calls for "humanism" require that we supplement the science of medicine with the healing arts? Or do they indicate that the physician, in addition tö his scientific expertise, must also develop a mastery of ethical distinctions andjudgments? Or is the appeal to "humanism" an injunction that the doctor move from a model of illness based on the natural sciences to a more encompassing framework that also includes the human sciences? If so, how can the doctor become an expert in so many disciplines? The difficulty encountered in trying to fit diverse humanistic and technological concepts and approaches into an encompassing scientific framework constitutes a crisis for scientific medicine. We shall...