Dr Russell Malcolm

 

 

 


Art in Medicine - An Outline of the Ideas

Two centuries ago there was enormous academic crossover between arts and the sciences. The empirical nature of medical practice at that time demanded great imagination, humanity and interpretative power. In the intervening years, various institutional, political and clinical demands have brought greater and greater reliance on knowledge-based practice. Although this has brought many benefits to the technical side of medicine, it has also resulted in less individualised care. This shift has occurred largely as a consequence of a drive to rationalise our models for living phenomena. Unfortunately, the rationalising process can be driven by many interests that have nothing to do with human care. Many commercial, political and financial interests have come to exploit the health care arena.

 

EVIDENCE BASED MEDICINE

The medico-political 'buzzphrase' of the past few years has been 'evidence-based medicine'. Yet, an increasing number of doctors question the wisdom of treatment algorhythms and protocols (often presented as 'guidelines') that now pervade every aspect of medical practice.

 

EVIDENCE CONSTRAINED MEDICINE

Bearing in mind that almost every great advance in medicine began as an empirical observation, this modern obsession with protocol risks institutionalising medicine. There is also a widely held belief among clinicians that the conclusions of population studies should inform the risk-benefit assessment in every individual case. If the individual circumstances of the patient are not precisely mirrored by the study population this assumption is not only wrong, but is also a dereliction of care, since treatment interventions always carry risk.  

At their worst, scientific ideologies transform astute medical judgement into poor service-provision. They can also inhibit individualised or 'person-centred' care and can even impair the doctor's ability to move away from treatment pathways that are failing individual patients.

'Evidence-constrained medicine' condemns many thousands of patients to suffer a stepwise increase in 'symptom management' - when often their problem would  resolve if the causes were properly sought and addressed.

Notwithstanding the importance of science in modern medicine, the avoidance of institutionalised thinking is vital, if the progressive dehumanisation of health care is to be avoided.

 

A Counterbalance to Determinism and Mechanisation in Health Care

The Arts and Humanities continue to respect the validity of individual expression and exploration. By respecting each unique narrative we open ourselves to the priorities and inner experience of our patients. We identify the contexts in which problems have evolved and we develop individualised strategies for change. 

 

The central  tenets of Art in Medicine are:

   
  • To respect the scientific advancement of medical knowledge, but avoid evidence-constrained medicine.
  • To foster systems-thinking in medicine.
  • To encourage a non-compartmentalised approach to human health and illness.
  • To encourage person-centred health care
  • To heighten awareness of the individual contexts for illness.
  • To avoid inappropriate use of population data in the formulation of individual treatment decisions.
  • To avoid basing treatment decisions exclusively on diagnostic labels without attempting to establish causation and pathography.
  • To promote safe, facilitatory treatment as our first response, whenever the prognosis allows.
  • To avoid manipulatory or interventionist treatment as a first response to illness, unless the facilitation of self recovery is unlikely to succeed, or the presentation is critical.
 

The content on this site has been written by Dr Russell Malcolm and is informed by long-standing personal involvement in both Clinical Medicine and the Arts.

 

Arts Background

Russell studied arts and humanities from 1993 to 1997. He graduated Bachelor of Arts and later advanced his long-standing interest in the performing arts with professional extra-mural studies in voice and drama. He has now 'clocked up' more than twenty years in medicine, medical education and the arts. Over this time Russell has become increasingly aware of  the potential for crossover between arts, humanities and medicine.

Over the last decade he has drawn on all three disciplines, allowing art and science to influence his daily work in ways that have direct practical relevance to his readers, students, patients and colleagues. 

In addition to his articles and books, Russell has written a considerable body of poetry and is a member of the poetry society.


For details of Medical Articles, Books and Publications - click HERE.

For details of  national and international Lecture Programmes - click HERE. 

Details of Arts and Crossover Topics are given below:


Single subject lectures

  • Early History of the Recorded Voice

Crossover lectures

 

See also: roles, recordings and poetry