Therapy: Art or Science?


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Is pain management an art or a science? Or both?
I am proud to call myself a clinical scientist, or scientist practitioner. This probably stems from when I started University study and enrolled in a Science degree rather than an Arts degree – even though the papers and courses were identical!

I went onto Google to search for ‘art’ and ‘science’ and pain management, and was amazed at the number of conference presentations, paper titles and articles with the words ‘art’ and ‘science’ – 280000 to be exact-ish.

I curious about the language used to describe pain management – while I’m reasonably comfortable with what I think science is all about, the way the word ‘art’ is used isn’t quite so clear.

Let’s get the science part out of the way first – the Merriam-Webster dictionary defines science as

1: the state of knowing : knowledge as distinguished from ignorance or misunderstanding

2 a: a department of systematized knowledge as an object of study
b: something (as a sport or technique) that may be studied or learned like systematized knowledge

3 a: knowledge or a system of knowledge covering general truths or the operation of general laws especially as obtained and tested through scientific method

b: such knowledge or such a system of knowledge concerned with the physical world and its phenomena : natural science

The key words are ‘knowledge’ and ‘system’ – so to me it implies something about systematically exploring and obtaining knowledge about our world.  There is no doubt in my mind that science and scientific methods have advanced our knowledge and practice in pain management over the past 40 years or more.

Science gets a bit of a bad rap.  It’s accused of being heartless, unfeeling, unemotional.  People believe science is contradictory – always coming up with ‘new’ evidence for something that is bad for you, or that something is good for you.  Science is thought of as hard to understand, somehow elitist, and isolated from the ‘real world’.  Science is often thought of as wanting to make things black or white when things are not so – but at the same time, science gets derided for speaking of probabilities or possibilities.

Artists similarly get bad press.  Artists are seen as flambouyant, zany, creative beings, perhaps slightly flakey and usually off-beat.  On the other hand, artists are also praised for daring to ‘be themselves’, for being in touch with their inner being, for their emotional responsiveness (if not their sensitivity toward others).

Older definitions of ‘artist’ draw on concepts such as ‘artisan’ or skill, technique or, as the Oxford Dictionary puts it:

  • A learned person or Master of Arts (now rather obsolete)
  • One who pursues a practical science, traditionally medicine, astrology, alchemy, chemistry (also obsolete)
  • A follower of a pursuit in which skill comes by study or practice – the opposite of a theorist
    • In health care, particularly medicine, the ‘artistry’ is about the ‘heart’ of providing medical care. That is, it’s more about the humanistic aims of health care, and how health care is delivered, than what is delivered (e.g. Hegde, 2006; Saunders, 2000). It’s about applying science in a way that honours the person. Again, science is viewed as somewhat inhumane.

      I’m not sure I agree that science is hard, cold and not about emotions and passion. Usually a real clinical question underlies the science of pain management. While the actual process of research is all about being diligent, patient and systematic, the reason for looking into these things is all about wanting to know and apply this knowledge to people. And one very easy way to ignite passion amongst pain management clinicians is to talk about ‘evidence’ for or against specific treatments!

      If science is about being systematic, acquiring knowledge, working toward understanding – then I’m equally hopeful that I’m a scientist. I hope I am well-informed about what does and does not work, and how my work affects the people who see me. If art is about skill, and being sensitive to emotion, then I hope I am an artist. I hope I use my knowledge about people, pain, therapies and so on to help people achieve their potential.

      What I hope I’m not is flakey, inconsistent and apt to change with the wind. I also hope I’m not cold, heartless and unemotional.

      How about you? Are you an artist and a scientist? Are you more one than another? If so, which side do you tend towards – and why? Join in the discussion – you can subscribe using the RSS feed link at the top left of this page. Or you can bookmark and visit. I blog most days during the week, and love comments. Remember that if you do comment, I’ll moderate (with a light hand!), and it will be visible to others. If you’d prefer to drop me a line, go to the About page and use the form there.

      Panda S.C. (2006). Medicine: Science Or Art? Mens Sana Monographs, III:6 (IV:1-4), 127-138

      Panda S.C. (2006), Medicine: Science Or Art? In : What Medicine Means To Me (Ajai R. Singh, Shakuntala A. Singh Eds.), MSM, III:6, IV:1-4, p127-138.
      Hegde B.M. (1999), Science and the art of medicine, Journal of Indian Academy of Clinical Medicine , 4 :1-3. Available at: http://www.indegene.com/main/issues/indlsses11.asp (Date of Access: 18 February 2006).
      Saunders J. (2000), The practice of clinical medicine as an art and as a science, Medical Humanities , 26 , p18-22. Available at: http://mh.bmjjournals.com/cgi/content/ full/26/01/18 (Date of Access: 18 February 2006

      7 comments

      1. Aren’t OTs both artists and scientists?

        As for pain management, I prefer “scientist”, but then I have a preference for treating it physiologically. However, in a recent discussion one of my peers mentioned the “fear avoidance model” which seems to use a more psychological reasoning for pain – sometimes psychology seems to be more art than science (to me anyway). Just my two cents.

      2. Ahhh, now as a person with some background in psychology, I’d say it’s most definitely scientific! The ‘art’ is in the deft application of therapeutic methods, which are based on hard science (hopefully). I use more cognitive behavioural approaches in chronic pain management than physiological per se – with the exception of self regulation/biofeedback. Tell me more about what you do!

      3. Great topics! Personally, I feel as an Occupational Therapist I cannot ignore the importance of science that underpins our profession, but in order to transform this science into everyday use for an individual – well that is an art. This may be something more than can be learned from textbooks and science, perhaps it is this art that makes some people choose to become an Occupational Therapist?
        The difficulty with the artistic side though is ‘how on earth do we justify our decisions when they are based on art’???

        1. Hi Jeremy, good to hear from you! Yes, I think you’ve got it in terms of the ‘art’ of picking and choosing the right intervention for the right person at the right time – and with sensitivity. And I do recall applying for occupational therapy because it had the ‘artistic’ side to it. Of course then I found out how little craft/art was involved!
          Clinical reasoning is based on logic and evidence, so I think that’s the scientific part – the ‘arty’ part might be more about the skill of communicating well with a person, perhaps the ‘heart to heart’ connection that is more than what you say, but how you say it?

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