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Medicine is more than just knowledge or skill
LANG Jing-he
Knowledge of medicine held by either physicians or Medicine, especially clinical medicine, is of course a
laymen is concept-based, but medicine itself cannot be skill, a highly specialized and complex one. The rapid
confined to concepts; it is based on a combination of development of other sciences and technologies has
image and concepts. Knowledge as information may be greatly promoted the progress of medical technology,
enough for the laymen, but is quite inadequate for even changed medical thinking, routes, and methods. At
physicians. Unlike other occupations that can be acquired the same time scientific advancements increases the
by self-study, one cannot become a physician by merely efficacy of diagnosis and treatment, but it also obscures
going through medical preparatory courses, basic and the disease picture, treatment scheme, or even the goal of
clinical medical courses, or by acquiring the bachelor’s, medicine – to treat an individual patient.
master’s, or even the doctorate degree. In fact, the 5-year
residency after graduation is actually the medical A review of the development in Western medicine reveals
apprenticeship. A resident learns from his or her “master” that a hundred years ago the focus of medicine was to
(consulting physician) how to treat patients. The main understand the human body.2 Over the last hundred years,
task is to validate his or her knowledge and convert it into breakthroughs in the field of medicine have improved our
clinical skills, which in essence is training and practice. understanding of disease and have brought about progress
This process cannot be bypassed or curtailed, no matter in diagnosis and treatment, thanks to the advancements in
how smart one is. One must know that the textbook other sciences as well. In addition to basic medical
description of symptoms is usually “the most typical”, but sciences such as genetics and molecular biology, medical
in clinical practice it is “the least typical”. applications of electronics, optics, instrumentation,
engineering, and computers have greatly changed the
Another feature of medicine is its humanistic nature. The outlook of medicine. The advantages brought about by
subject of medicine is the human being, who has science are clearly encouraging. On the other hand, it
thoughts, feelings, consciousness and will, and living becomes worrisome when clinicians become pure
within a family and society. Every human being has
different physiological and psychological characteristics. DOI: 10.3760/cma.j.issn.0366-6999.2012.07.001
Individual differences are so large that “sit by number” Department of Obstetrics and Gynecology, Peking Union Medical
knowledge oftentimes “cannot find the seat”. There are a College Hospital, Beijing 100730, China (Lang JH) (Email:
hundred manifestations in a hundred people suffering langjh@hotmail.com)
1204 Chin Med J 2012;125(7):1203-1205
Medicine is wonderful in that many of its aspects are Medical practice is a process in which every gesture and
unexplainable. We must fill the gap between what we action of a doctor reflects the internal character, more
know – our knowledge, experience, and skills – and the than technology. Seeking medical advice is also a
problems we need to solve. At the same time, we need to process, where at all times patients care about internal
seek out answers to medical problems, we should feelings more than results.
consider patients even more, focusing on their quality of
life, and paying attention to the value of medicine. Another basic medical activity, clinical diagnosis and
“Value” here refers not just to the prolongation of treatment, is primarily a philosophical action and ethics:
patients’ survival but also to the improvement in their namely, the aforementioned philosophical reasoning and
quality of life, as well as social benefits of medical decision-making. Professional training and technical
interventions and macro health policy. Treatment does not learning are important without doubt, but a humane spirit
always mean curing a disease, but includes compassion and philosophical outlook are fundamental and lifelong.
and relief of pain. We have to know that moral merit is a kind of intelligence
also. Misunderstanding or lack of ethics may lead to
The alienation between technological advancement and technical weakness or mistakes. We tend to close down
humanitarianism once we are on the track of knowledge. If we surrender to
As early as 100 years ago, Sir. William Osler4 pointed out temptation to do so, then how can we enjoy the intense
sharply the drawbacks of medical practice: lack of beauty of the blending of science and art? How can we
historical insight, a break between science and the obtain wisdom from their mutual encouragement? Only
humanities, and the alienation between technological when we practice from the essence of medicine can we
progress and humanitarian compassion. These three really enhance our professional insight, wisdom, and
problems, now intensified, continue to hinder the spirit.
development and reform of modern medicine and health
care. REFERENCES
In conclusion, medicine is not a pure or perfect science. 1. Hamdorf JM, Hall JC. Acquiring surgical skills. Br J Surg
On the contrary, it is a system of knowledge, technology, 2000; 87: 28-37.
and awareness that is elusive and constantly changing. Its 2. Porter R. The Cambridge history of medicine. Cambridge:
object is the health of a living organism, a human being Cambridge University Press; 2006.
with thoughts, feelings, consciousness, will, and family 3. Higginson IJ. Rediscovering dignity at the bedside. BMJ
and social context. 2007; 335: 167-168.
4. Osler W. A way of life. Charleston: BiblioLife; 2009.
Also, doctors and patients differ in their experience,
feelings, and ways of thinking. As we try to come up with
core medical values and healthcare rules, we should first (Received August 24, 2011)
keep in mind that “patients are the most important!” Edited by CHEN Li-min