The Art of Medicine is Not an Algorithm

(From my "The Art of" series)

The Art of Medicine is such a common phrase because, for many centuries, medicine has not been a cookie cutter activity. It has been a personalized craft, based on the science of the day, practiced by individual clinicians for diverse patients, one at a time.

Unlike industrial mass production, where everything from raw materials to tools to manufacturing processes are standardized and even automated or performed by robots, physicians work with raw materials of different age, shape and quality in what is more like restoration of damaged paintings or antique automobiles.

The Art of Medicine involves knowing how and with which tools to take something damaged or malfunctioning and make it better. There are general principles, but each case is different to at least some degree. In many cases there are different ways to improve something that is malfunctioning, but patients may prefer fixing certain aspects of a complex problem because of their individual needs.

Restoring a very old car may be a different process depending on its intended use, like parading it in car shows or driving cross country. Patients’ desires and expectations can vary just as much.

The view on optimal treatment of high blood pressure has become a vision of automation to the degree that many have proposed letting pharmacists follow protocols, actually prescribing and dispensing medications for better control.

But patients don’t usually fit into such manufacturing mode paradigms. Some hypertension patients also have swollen legs, rapid heart rates or blood pressure spikes when feeling stressed. Some have naturally low potassium levels or cold feet in the winter. A careful and individualized choice of blood pressure medication can make the whole person feel and function better, treating more than one thing at a time. Knowing all the available medications intimately is infinitely more valuable to the patient than blindly following the treatment algorithm of the day – because we have all seen them come and go.

To paraphrase Hippocrates: The Life of algorithms is short, the Art of practice is long.