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.”
