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You may have heard that medicine is both a science and an art.  What does this mean, ‘art’?  Is it a painting or sculpture or something?

Art is difficult to describe, but when I asked my spouse who is an artist, he says that art is expressing an idea in a purposeful way not previously considered.

The painting above, for example, reconsiders a breeze rustling through grass and an olive tree.

Medicine is more difficult to describe as an art because it feels like it should be concrete and set in stone.  I think 80% of the time it is.  Physicians are taught to recognize patterns of symptoms or conditions to determine and diagnosis,  and then apply our knowledge to treat the disease.  We have a saying, ‘when you hear hoof beats, think of horses and not zebras’ because common is common such as a cold.

The art reveals the 20% of the time things don’t quite fit into a usual pattern, or patients don’t seem to get better.

If there is a ‘zebra’, we have to apply a different set of thinking to determine a diagnosis which was not considered previously.  The thought process might combine science of our fund of knowledge, or we might have to rely on our senses, including the sixth sense of intuition, or it might involve discussing with many other people if they have had similar experience.  It’s a more complicated process where we sketch out thoughts to come up with the big picture of what is going on to treat disease.

Thankfully, most of disease falls into the 80% or greater category.  I happen to enjoy the 20% where conditions are complex and confounding.  If I am still not coming up with a diagnosis, I involve my other colleagues to ask if they have seen similar patterns in their practice.

When I am correct and I have helped patients with complicated conditions, I feel I have practiced an art.