Is What We Do A Science Or An Art?

It’s both. And that can create quite a problem sometimes. OK … often.

Some EMTs are scientists. They see medicine in very linear, protocol driven flow charts. If the chief complaint is X then check Y and administer Z. They like statistics. They talk about efficacy percentages and risk-benefit calculations. If they can analyze the data … they can find truth. Within the beautiful geometry of research they can discover the perfect algorithm of care and believe that, by doing so, the patient will be served.

When it works, science based medicine is a beautiful thing. The problem is … well … it doesn’t always work. We are treating humans. Humans are an anomaly. They are the rouge element in the scientific plan. Human beings are the perfectly imperfect wild card in an otherwise flawless equation.

Some EMTs and paramedics are true artists. They approach each new clinical presentation with a haphazard mix of established treatment and gut instinct. There decision making process may hinge on such variables as the weather, the last EMS magazine article they read and which doctor is on duty at the base hospital. They tell jokes. They inspire movements. They throw together treatments like Jackson Pollock splashing paint on a canvas. They write deviation from protocol addendum’s. They surprise people with their knowledge and, in many cases, they give outstanding care.

And the scientists ring their hands in frustration.

This causes some problems:

1.) The people on the outside get confused.

They want us to quantify what we do and have good reasons for our actions. We are a microcosm of the medical machine and we should be aligned with its scientific roots. People on the outside don’t have a mastery of the details so they struggle with variables. Why wouldn’t you treat every chest pain patient with the same medication? Why would you start and IV on one patient and not another? “Shouldn’t we be driving to the hospital right now?” Outsiders want us to be predictable. They want to know who’s going to show up. That’s harder when we’re in the middle of our own identity crisis.

2.) We get confused.

Are we in the middle of an art project or a science project. It helps to know what we’re being graded on. If you go to school to learn emergency medicine and your instructor teaches it as if it is a scientific equation, you’re going struggle to apply your knowledge to situations that demand a basic gut decision. If you approach patient assessment and treatment as a pure art form, you’re going to frequently founder for direction and you’re going to occasionally miss the obvious.

I’ve never seen anyone become really great in his field without somehow figuring out how to wear the art and the science like a pair of gloves. Standing in between those two roles and using them both in tandem. Some folks will ague that one is more essential than the other. If that’s true, I have yet to figure out which. I only know that within each role, the artist and the scientist, there is something essential. Something we can’t do without. Not if we want to be good.

 (Inspired by Seth Godin)

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  1. I never thought of what we do quite like that, very interesting concept. I tend to veer more toward the artistic side, maybe because most of my patients are real pieces of work. Or works of art.

  2. brendan says:

    So do you not see pre-hospital medicine as requiring a science and evidence-based medicine approach? There’s more to being a scientist than following protocol verbatim.

  3. Steve Whitehead says:

    On the contrary Brendan. It is required. It is an essential half of the equation. Science isn’t about following the protocol … It’s about creating and validating the protocol. That’s a vital step in the process. 😉

  4. To some degree the patient presentation helps guide which pair of gloves to use – artist or scientist. A patient with a chest pain presentation that easily fits in the chest pain protocol is well suited for the scientist approach.

    A patient with a vague complaint or complaint that has symptoms that does not match potential problems is suited to an artistic approach. My medical director told a story about a recent patient with altered mental status. Mid 40s, no headache, no facial droop, no one sided weakness, normothermic, normal SPO2, normal blood sugar, normal electrolytes, normal EKG. Which protocol does this guy fit?

  5. I vote scientist first… once someone has 5 years of experience under their belt, they can cultivate their artistic side. 😛

  6. I agree that the scientist needs to hold the trump card. But the two can work in tandem. They don’t need to be in conflict.

  7. Short answer. Yes.


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