FREE ESSAY ON ADVANCES IN MEDICINE

ADVANCES IN MEDICINE

As the history of medicine has evolved, a number of trends and prevailing opinions have
swept the profession. One of the most subtle, and yet most revealing results of these
sweeping trends manifests itself by altering the tone in medical conversations and
dialogues, often available to the non-medical person in the form of texts and literature.
A relatively current example appears in the form of Perri Klass' A Not Entirely Benign
Procedure, a text dedicated to the experiences of the author at Harvard Medical School.
Published in 1987, Klass' work offers an interesting, if not shocking comparison to
Philippe Pinel's "The Clinical Training of Doctors," an article published in 1783. It
seems that, despite the obvious advancements and progress in medical technology and
general care, the modern Klass presents less certainty about the profession and its
abilities than does the eighteenth century article. In Pinel's article, however, a
distinct tone of holistic healing pervades the proposed training of physicians-the lack
of which Klass bemoans in her work. The contrast between the two works affords the reader
a view into two parallel transitions in medicine: the decline of certainty and the
decline of holistic care.
One of the most shocking aspects of Pinel's article involves the specificity in patient
setting and observation he demands. From precise measurements of the weather to room
orientations, Pinel seems to imply that precision in observation and care-giving will
lead to precise diagnoses and eventual cures: "It is obvious that medical observations
can be precise and conclusive only if the evidence is reduced to the smallest possible
number of facts and to the plainest data." The outline for the training of physicians
Pinel proposes attempts to create an environment that allows the kind of precision that
will lead to conclusive outcomes in patient care. Pinel's demands range from the sensible
to the seemingly outrageous. His proposal to closely scrutinize the diets of patients, as
well as to experiment with these diets, seems to coincide with modern beliefs and
practices. Indeed, just as Pinel recommends, one of the first and fundamental questions
asked by any physician or health care provider involves an investigation into previous
food intake. Most of his section entitled Questions to ask upon admitting a patient
conforms with modern practice. The more extreme requests and propositions, however, offer
a more penetrating insight into his and his time's beliefs concerning the potential of
medicine.
Pinel requires that his teaching hospital be equipped with a battery of meteorological
instruments in order to enhance the level of precision in determining the potential
influences on patients. To function accurately and properly, the physician must account
for all possible influences on the health and condition of the patient: "Notes on
celestial observations, meteors, and the phases of the moon should complement the daily
recordings from these [meteorological] instruments." Oddly, this level of observation
requires a near impossible exertion of effort on the part of the physician, and it would
be a wonder if the patient did not succumb to his illness by the time these initial
observations were made. The implications of Pinel's suggestions include the assumption
that a cure can be found, and precise scientific scrutiny will inevitably reveal its
location. 
As an interesting aside, Pinel wrote well before the time of scientists like Heisenberg
(circa 1900), who helped elucidate the fundamental impossibility of knowing all the
possible outcomes of a situation by merely understanding the initial conditions of that
situation-the premise of modern Chaos Theory. Heisenberg's Uncertainty Principle was a
watershed moment in the general paradigm of science in that it posited a limit on the
accuracy of observation. Knowledge of the position of a particle came at the expense of
knowledge of its velocity, and knowledge of velocity, at the expense of position. One of
the hallmarks of modern science includes its attempts to cope with the realities and
implications of unconquerable fundamental uncertainties. In some small way, Klass conveys
this general scientific uncertainty from a personal perspective, which in turn reveals
its presence in the entirety of medicine.
In her segment entitled Curing, Klass depicts the presence of uncertainty in the modern
medical profession. She does not deny that the expectation of cure still represents the
model of the physician, but she does mention that this needs to change. Her reasoning is
simple: "It's frustrating to want to cure, to carry with you the expectation that somehow
you should be able to cure, and then not be able to cure." She intensifies her point, and
provides evidence for the fact that this is not merely her own personal opinion, but
rather more far-reaching in medicine, when she describes what she is told when learning
about a treatable, curable illness: "And this one really makes you feel like a doctor."
The true sense of physician only comes with cure, but Klass, and many other physicians
come to realize that there exists much they cannot cure. Because of this, Klass argues
for emphasis on such things as preventative medicine and "life-style issues" -an argument
that remarkably resembles the holistic manner of care presented in Pinel's article.
As the best method to teach medicine, Pinel advocates the training of the physician as a
comforter, as well as a healer. He remarks on a number of psychological remedies which
result in the increased comfort of the patient. His argument stems from the belief that
despair leads patients to an early demise, and that positive thought aids in recovery and
cure. Comfort and activity, resulting in mental well-being are indispensable tools of the
physician in his attempt to alleviate illness. Klass laments the fact that modern
physicians, in the face of failing diagnosis or treatment, request more tests and more
adventurous invasive procedures, rather than adjusting to a role of comforter and
caretaker. Pinel advocates only the simplest medications and interventions in an attempt
to cure, and notes that most often, as in the example of Hippocrates, diet is the source
of cure. Pinel does not waiver from his pursuit of cure, but his methods incorporate a
more holistic and comforting manner in which to seek it-more holistic and comforting than
the manner in which Klass observes its search in modern medicine.
An odd, but unmistakable parallel begins to emerge from a comparison of these two works
by Klass and Pinel. While medicine supposedly advances as history progresses, certain
vital aspects are noticeably missing. Advances have led to some understanding, as
evidenced by Klass, that the search for cure should not serve as the model for the role
of the physician. The implications of this understanding, however, do not manifest
themselves in modern medicine, where a failure to cure represents a failure of medicine,
and a failure on the part of the physician. Without the benefits of technology and, more
importantly, without the benefits of the radically influential ideas of Heisenberg and
others, Pinel hopes and writes assuming that every cure can be found through careful
scrutiny and observation. He also writes knowing that physicians in his day do not
successfully cure all patients. It seems that from this practical knowledge, Pinel
derives his argument for a holistic approach to medicine: "train their judgment rather
than their memory and inspire them with that noble enthusiasm for the healing art that
masters all difficulties." Technology has afforded modern medicine with the illusion that
more tests and more procedures can cure the patient-an illusion not too far removed from
that of Pinel. Unfortunately, in the case of modern medicine, the need for more holistic
methods of care-giving, as illustrated in the writings of Klass, remains unsatisfied,
despite evidence indicating that even the most precise observation and care cannot solve
all problems. While progress in medicine has left unparalleled technology and knowledge
at the disposal of the modern physician, it has left behind a holistic and comforting
manner of care that would greatly enrich the role of the physician and medicine.