The Art of Medicine and the Science of Technology Paul Salins
Health care has always needed technology to reduce the cognitive burden of delivering care, overcoming uncertainties inherent in an experience-based decision process, and bringing the medical profession closer to coping with the tremendous emerging knowledge in medicine. The marriage between technology and health care is expected to simplify, accelerate, and render critical health care processes more predictable, in turn reducing dependence on expertise and experience. Therefore, it could be argued that the limit to which the human body can be perceived as a machine, and the practice of medicine largely a technical process, would be the extent to which health care of the future would improve outcomes and become available to all. Cardiac surgery was once rightly regarded the most challenging of surgical procedures, but today, given advancements in technology and our improved understanding of anatomy as well as biological and technological processes, it can be performed in a production-line process, providing consistent outcomes and significant cost reduction. Production lines in eye surgery have similarly brought sight to millions. Yet, most of medicine still remains what Sherwin Nuland has termed “an uncertain art� in a landscape of ever-changing facts unseating the old. This uncertainty calls for considerable judgment on the part of providers in determining management choices. Yet, an ever-expanding universe of medical facts, evidence-based medicine, randomized control trials, clinical prediction rules, and treatment algorithms can easily corrupt the value of this art and demote perception of medical practice to the level of a technical exercise capable of mechanistic certainty. As the demands on the medical profession have become overwhelming, as in Harvard South Asia Institute 37