外科是一门艺术还是一门科学

Surgery: art or science

  • 摘要: 究竟医学是科学还是艺术,有很大的争议。有人说这应是一门科学,也有人觉得是一门科学加艺术的学科。还有很多人认为这是一门使用艺术应用于科学的学科。外科是医科中主要通过用手操作治疗病人的学科,这方面的争议更大。现代外科,开始于19世纪80年代,当时解决了手术带来的三大难题:疼痛、感染和出血,使外科发展十分迅速。现代外科的建立,是通过解剖学、生理学、病理学和诊断学的基础知识,发展成为外科学,用于治疗疾病。可以说,外科是通过科学的发展而建立起来的学科。决定通过外科治疗疾病,也应使用科学的方法来权衡治疗对病人带来的利与弊,即基于当时的最佳循证医学证据而决定。可惜的是,科学不能解决现在外科医师在临床上遇到的所有问题。循证医学虽然近年发展很快,但在很多外科领域中还是一片空白。在这种情况之下,外科医师只能通过自己的经验、基础知识作出决定。这种治疗方法,也成为科学与艺术的结合。此外,准确、适当和合时的临床判断,也是艺术和科学的结晶。同样外科技术的建立,学习一种新技能也是通过科学的方法进行,即是从科学开始。但技术上的应用和外科上的创新,需要结合科学和艺术才能开展。现代外科是通过科学建立起来,在治疗病人方面,要求是艺术应用于科学。外科创新是科学与艺术的结晶,才能把外科学推到更高的层次。

     

    Abstract:  There have been a lot of debates on whether medicine is art or science. Some consider medicine as a discipline of science, others consider as a discipline of science and art, while some others consider as application of art on science. Surgery is a specialty in medicine in which clinicians use their hands to heal patients. It is not surprising that whether surgery is art or science is even more controversial. Modern medicine began in the 1880s when the three major problems in surgery were overcome: pain, infection and blood loss. Since then surgery has developed very fast. Modern surgery is established on the basis of science: from the basic knowledge of anatomy, physiology, pathology and diagnostic radiology, modern surgery evolves to treat diseases. There is little doubt that in the ideal world even surgical decision-making should be based on science and evidence-based medicine. Unfortunately, science cannot solve all of problems encountered by surgeons in their clinical practice. With the rapid development of evidence-based medicine in the past few decades, there are still a lot of areas in surgery where there is no good evidence to guide clinical decision-making. Under these situations, clinicians can only rely on their knowledge and experience to make a judgement—the application of art on science to make a medical decision. Moreover, accurate, appropriate and timely clinical judgement is also a combination of art and science. Similarly, the development of surgical skills is based on science. However, the merging of science and art produces application of technique and surgical innovation. Modern surgery is developed based on science. The application of art on science is sometimes required to make clinical judgement, especially intraoperative judgement. Surgical innovation,which combines science and art, helps to improve the standard of surgery.

     

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