Shen-Han Lee

Reports here . More about the man here and here. Detailed biography here.

M. Judah Folkman, the legend behind the theory of angiogenesis in the development of cancer, has died. A clinician-scientist par excellence who weathered through the storm of skepticism in the early days of his career, Dr Folkman leaves behind a legacy of using anti-angiogenesis drugs to make cancer a manageable disease, very much like diabetes and ischaemic heart disease. Having read his works, publications, reflections, and memoirs during the ‘Pharmacology of Inflammation and Angiogenesis’ module of my Part II undergraduate course in Pharmacology at Cambridge, I count Dr Folkman as one of my heroes in science and medicine.

May you rest in peace, Dr Folkman. 

London’s Medical Student Newspaper recently ran a feature interview of Dr Elias Zerhouni, the big guy of that obscenely cash-abundant institution just to the northwest of D.C. Read the full piece of work here.

One thing that caught my eye was the last part of the interview, when Dr Zerhouni was asked of his views on where the future of medicine lies. He replied:

“Well, fasten your seat belt because it’s going to be fun. Medicine is going to change more than ever; firstly its knowledge content is going to improve tremendously. Also, instead of being curative and intervening when patients are sick you are going to have to intervene much before the disease actually strikes.   We will be in era of 4 P’s.  Predictive medicine, 

Personalisation regarding genetic variation,

Pre-emption, the natural consequence of knowledge, and finally

Participatory, the patients will be more involved in their own health care.” 

His words really got me very, very excited. Excited that the future holds so much promise!

One thing which has always intrigued me is the statement that ‘medicine is both an art and science’. Having completed the two years of my preclinical medical sciences and one year of pharmacology as a natural science subject, I have come to understand the second part of the statement – medicine as a science. And now, on the threshold between the preclinical and clinical phases of my medical training, I feel it is timely to ponder upon the ‘art of medicine’.

What exactly is the ‘art of medicine’?

Well, according to Eugene Braunwald, MD et al. (2006):

[quote]

When a patient poses challenging clinical problems, an effective physician must be able to identify the crucial elements in a complex history and physical examination, and to extract the key laboratory results from the crowded computer printouts of data, in order to determine whether to ‘treat’ or to ‘watch’.

Deciding whether a clinical clue is worth pursuing or should be dismissed as a ‘red herring’ and weighing whether a proposed treatment entails a greater risk than the disease itself are essential judgments that the skilled clinician must make many times each day.

This combination of medical knowledge, intuition, experience, and judgment defines the art of medicine, which is as necessary to the practice of medicine as is a sound scientific base

[/unquote]

So, basically, all the amount of textbook medical knowledge will be worthless if a clinician fails to exercise prudent judgment in evaluating the clinical signs and symptoms. Thus, a competent clinician is one who has mastery of BOTH the science and art of medicine.

But does this de-emphasize the importance of having a sound knowledge in the medical sciences? The answer is a resounding ‘no’. In fact, the opposite is true. Without a good grounding in the sciences, the physician is analogous to a person with visual agnosia (well, not literally, but figuratively) – in that, one is able to observe and extract the signs and symptoms from the patient, but fails to relate them to a coherent body of medical knowledge.