Medicine - the science vs. the art

So, here's the question: is medicine a science or an art?

As a medical student it's pretty easy for me to answer this question: It's both! This is why I think so.

I spend tons of time learning the way the books tell it, numbers, names, disease after disease. Yet when I go into a case study group being led by a doc, I'm always amazed at how wrong I can get it when it comes to a patient's real case. Even when I have all of the information needed infront of me. Why?

It's because the art is in the integration. The science is about little pieces of the patient, disease A, disease B, risky behavior C, but patients are not a composite of their diseases. Real patients are more complex than that. The art of medicine is making sense of all of the inputs from the science side and the inputs from the softer side, the human side: someone's lifestyle, their attitudes towards certain things, their desire to know or not to know. The literature may give you a double blind study telling you what the best treatment is for shingles but if the patient can't pay for famcyclovir, what are you going to do? You're going to use the art of medicine to a) find a solution that you are both happy with b) do the best for your patient that you can. This may involve giving that patient in particular free samples or calling up the drug company to tell them your story (big pharma will be another topic). There is no book or journal article that will tell you how to do that.

There is also no journal article or book that tells you what makes this patient comfortable in your office and what you can do for them today. The art is in asking the right questions and listening long enough to get the whole answer. The art is also in knowing when a patient is not telling the whole truth. Patients may say they never lie but it's not true - we all lie when we think we're being judged or someone's not going to take us seriously, it's just usually called exaggeration or "bending the truth".

So yes, the evidence-based part of medicine is important and is definitely better than the paternalistic model from days of old, but the art will never be eliminated from practicing medicine.