NHS is so under-pressure from Covid-related backlog that it risks losing life-saving compassion – Professor Harry Burns

Is medicine an art or a science? Perhaps we will soon find out.

Combining the science and art of medicine to understand the needs of patients results in significant health benefits (Picture: Steve Parson/PA)

When medical students go to university, they study sciences relevant to medicine. Biology, biochemistry, physiology, anatomy are studied in the early years with subjects relevant to diseases like pathology and microbiology coming later.

Students study the causes and consequences of illness. They study how it affects the body, how it can be diagnosed and treated. Medical degrees focus on learning the science of illness.

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If medicine is an applied science, every patient in whom a particular condition is diagnosed should be treated the same way. Where research has shown clearly what causes a problem and what treatment is effective, the science tells us that the solution to the problem is that treatment.

This is “evidence-based medicine”. It is the application of guidelines, quality standards and regular audits of outcomes. Undoubtedly, such disciplines have produced spectacular improvements in outcome of care for many conditions.

Those who consider the practice of medicine as an art tend to see beyond the disease and its treatment, and consider the broader needs of the patient. They see that meeting those needs as an "art” is as important as following the science.

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When doctors see patients, the good ones try to get an understanding of what is concerning them. They are thinking about how to reassure and support them, not just the science.

GPs get to know patients by supporting them through births, illnesses, deaths. Their conversations build trust and insight. Sometimes, these insights allow the doctor to see that conventional investigation and treatment is not what the patient needs.

Currently, the NHS has been overwhelmed by the pandemic. As it tackles the resulting backlog of investigations and operations the pressures will be to focus on guidelines, protocols and getting patients through the door. Will the support of patients through empathetic and understanding consultations suffer? I suspect it is already suffering.

I was reminded of this recently when visiting family in England. One of their neighbours was an old school friend who also became a doctor.

We talked of old times, but, particularly, we remembered our friend Professor Kieran Sweeney. On leaving school, he studied art history. He went on to study medicine and eventually became professor of general practice at Exeter University.

Through him, I met a remarkable man, Julian Tudor Hart, a GP in the small Welsh village of Glyncorrwg. He was part of his community and knew the people as friends rather than patients. He once said, "how ignorant I would be if I knew them only as a doctor seeing them when they were ill".

Eventually, a study showed premature mortality was 30 per cent lower in Glycorrwg than in neighbouring villages. Combining scientific medicine and the art of empathy and understanding the needs and perspective of patients produced significant health benefits.

Kieran died, in his 50s, of the asbestos-related cancer, mesothelioma. He was committed to the art of medicine which he saw as having a compassionate relationship with patients. A video of him describing his experiences as a patient can be found on YouTube.

The pressures on the NHS to clear the backlog might impair its capacity for empathy and compassion. I hope not.

Sir Harry Burns is a Strathclyde University professor and ex-Chief Medical Officer for Scotland

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