Physicians as Artists

“Did you know, Julie, that Dr. Brent James and Dr. Jay Kaplan have characterized physicians as artists or craftsmen?”

“That sounds like a compliment, Curmudge. To me, a painting or sculpture is the product of the brain and hand of a single individual, and those I’ve seen in Chicago appear to have been done by artists with great talent.”

“But remember, Julie, that every artist and original work of art is unique, and only the best works are hung in museums. Does that suggest what James and Kaplan had in mind when they depicted physicians as artists and craftsmen?”

“Surprise, Old Man! I’ve done my homework. As James said, ‘We continue to rely on the "craft of medicine", in which each physician practices as an independent expert—in the face of huge clinical uncertainty (lack of clinical knowledge; rapidly increasing amount of medical knowledge; continued reliance on subjective judgment; and limitations of the expert mind when making complex decisions.).’ Results of physician ‘artistry’ include: ‘Well-documented massive variation in practice based on local medical myths, high rates of inappropriate care, and unacceptable rates of preventable care-associated patient injury and death.’ “

“Of course, I wouldn’t mind being treated by a Michelangelo-quality physician-artist if I had an obscure, hard-to-diagnose ailment. Maybe even several of them if I were at the Mayo Clinic. However, as Levy has stated, ‘the vast majority of medical care is not complex; it calls for standardization, adoption of protocols, and scientific experiments of process improvement to modify those protocols to enhance care and reduce harm.’ “

“Curmudge, this is what I see as the problem. Physicians of the past and present were trained to be artists. That sort of training is likely to be insufficient for the future. That’s a problem that you and I can’t solve, but we’ll share with our readers whatever we can learn from the experts.”

“Back on February 16 in Kaizen Curmudgeon we quoted Brent James’s proposed countermeasure, but there is more to be said about a path forward. We’ll continue our discussion next time.”