Advances In Medicine Essays - Philippe Pinel, Perri Klass, Medicine

Advances In Medicine Essays - Philippe Pinel, Perri Klass, Medicine 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 Pinels 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 Pinels article, however, a distinct tone of holistic healing pervades the proposed train ing of physiciansthe 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 Pinels 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. Pinels 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 provide r 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 times 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 Pinels 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 situationthe premise of modern Chaos Theory. Heisenbergs 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