In the “be careful what you pray for, you may get it” department, evidence-based medicine is one of those prayed for results—which does not work quite as prayed for.

The inherent tensions between the science and the art of medicine have never been more clear or harder to reconcile.

For many decades, the lag time between discovery and a care improvement at bedside was measured in years.

It was sad to hear someone talk about a family member, whose doctors had said, “This is all that we can do,” knowing that there was, in fact, more doctors could do for a patient with that diagnosis.

Evidence-based medicine has come of age.  Many dismissed it early on as “cookbook medicine. ” Open the book. Follow the recipe. That’s not real medicine.

No, it is not.

This is an abstract in an Art of Medicine essay from The Lancet in which the author discuses the tension between evidence and art—with attention to its role in patient-doctor relationships.

The Lancet

“Medicine is a science of uncertainty and an art of probability” mused William Osler. In The Lancet today, Caroline Wellbery extols the value of uncertainty in her Art of Medicine essay. To her, the onion skin of uncertainty is liberating, rather than constraining. She argues that uncertainty should be embraced because of the opportunity it provides doctors and patients to engage on more profound levels and reflect on alternative possibilities. (Emphasis added)

“Many practitioners already use such an approach, recognising that the potentially destructive vacuum caused by uncertainty can attract excessive investigations by physicians, and turn patients away to alternative practitioners, who might actually be peddling greater certainty. Researchers welcome clinical uncertainty as a source of knowledge gaps, whose answers will be meaningful to clinicians and patients.

“Wellbery’s essay raises a potential tension: should the role of doctors be mainly to manage risk or to help individuals cope with uncertainty about health and disease? In reality, both roles—objective and subjective—are important and complementary. Doctors need sound training in the science as well as the art of medicine to be competent at reducing uncertainty and comfortable in addressing it.“ (Emphasis added)