Why medicine is like philosophy

Abstract

‘Is not medicine the science of health?’ asked Plato. Not quite, if you fully consider this month's JRSM, an issue published a century after the rebirth of the Royal Society of Medicine in its current form. December offers an opportunity to contemplate the deeper questions of clinical practice, and my take-home message for the holiday season is that medicine is more comfortable and more fascinating as a science and an art. Jane Roberts begins the issue with a feminist critique of the Spice Girls and ends with a plea for academia to recognize that women have a dual role as doctors and engaged, responsible parents (JRSM 2007;100:532-3 and 583-4). Family friendly policies, she argues, have no real currency in the world of academic medicine. Indeed, why should the emotional well being of children of doctors be ignored? What does this say for our society, other than it is in a perilous state? The hegemonic medical structure that Roberts describes was even more evident a century ago when the Royal Society of Medicine first appeared in its current form with academic sections, and when Dr Gee, the president of the medical section, invoked the vision that Boethius saw in his prison in Pavia: Philosophy appearing before him in the form of a majestic woman, clad in an imperishable robe she had woven, but the beauty of her vesture ruined by violent hands tearing away as much as each could clutch. The many sects and sections of philosophy, argued Dr Gee in 1907, were the mirror of medicine (JRSM 2007;100:535). John Scadding, the current Academic Dean of the RSM, considers Dr Gee's analysis in a modern light and concludes that Dr Gee's concerns about the fragmentation of medicine are relevant today and will still be of importance in a hundred years time, just as the role of the RSM in medical education remains unchanged and will continue to remain so (JRSM 2007;100:536-7). One important difference, however, is technology and the challenge it poses to traditional clinical skills. In a throwback to the life and times of Dr Gee, Kartick Thirukkanesan and colleagues present the case for cardiac percussion in the diagnosis of cardiorespiratory disorder (JRSM 2007;100:533-4). They argue that area-based dullness can be useful in the diagnosis of atrial enlargement and right ventricular hypertrophy or dilation. A generation of doctors brought up on ECGs, chest X rays and echocardiograms might be hard to persuade, although many doctors do still enjoy the thrill of making a diagnosis without artificial assistance. Another important clinical skill is diagnosing death. In one of my junior doctor posts, a colleague certified the death of one her patients, called in the family, who were only too delighted to find their relative sitting up sipping a cup of tea when they arrived in hospital. I had assumed this was sheer bad luck—or good luck depending on your perspective—until I read this month's review on the Lazarus phenomenon, described as a delayed return of spontaneous circulation after cessation of cardiopulmonary resuscitation (JRSM 2007;100:552-7). The story of Lazarus tells of how he was resurrected by Christ four days after his death, which leads us back to the art and science of medicine in this seasonal issue of the JRSM—and the futility of doctors. Bernadette O'Hare and David Southall demonstrate an association between recent conflict and higher rates of under-5 mortality, malnutrition and maternal mortality in Sub-Saharan Africa (JRSM 2007;100:564-70), while Mike Clarke and colleagues prove—probably not beyond reasonable doubt—that the status of the signatory of a letter has no effect on the likelihood or promptness of response, not even if that status was conferred by the British monarch (JRSM 2007;100:571-2). Apologies for finishing on a negative note for all of you expecting letters from the Queen, but the rest of us will take pleasure from this conclusion—and, I hope, from the rest of this month's issue.