Skip to main content

Main menu

  • Home
  • Content
    • Current issue
    • Past issues
    • Early releases
    • Collections
    • Sections
    • Blog
    • Infographics & illustrations
    • Podcasts
    • COVID-19 articles
    • Obituary notices
  • Authors & Reviewers
    • Overview for authors
    • Submission guidelines
    • Submit a manuscript
    • Forms
    • Editorial process
    • Editorial policies
    • Peer review process
    • Publication fees
    • Reprint requests
    • Open access
    • Patient engagement
  • Physicians & Subscribers
    • Benefits for Canadian physicians
    • CPD Credits for CMA Members
    • Subscribe to CMAJ Print
    • Subscription prices
    • Obituary notices
  • Alerts
    • Email alerts
    • RSS
  • JAMC
    • À propos
    • Numéro en cours
    • Archives
    • Sections
    • Abonnement
    • Alertes
    • Trousse média 2023
    • Avis de décès
  • CMAJ JOURNALS
    • CMAJ Open
    • CJS
    • JAMC
    • JPN

User menu

Search

  • Advanced search
CMAJ
  • CMAJ JOURNALS
    • CMAJ Open
    • CJS
    • JAMC
    • JPN
CMAJ

Advanced Search

  • Home
  • Content
    • Current issue
    • Past issues
    • Early releases
    • Collections
    • Sections
    • Blog
    • Infographics & illustrations
    • Podcasts
    • COVID-19 articles
    • Obituary notices
  • Authors & Reviewers
    • Overview for authors
    • Submission guidelines
    • Submit a manuscript
    • Forms
    • Editorial process
    • Editorial policies
    • Peer review process
    • Publication fees
    • Reprint requests
    • Open access
    • Patient engagement
  • Physicians & Subscribers
    • Benefits for Canadian physicians
    • CPD Credits for CMA Members
    • Subscribe to CMAJ Print
    • Subscription prices
    • Obituary notices
  • Alerts
    • Email alerts
    • RSS
  • JAMC
    • À propos
    • Numéro en cours
    • Archives
    • Sections
    • Abonnement
    • Alertes
    • Trousse média 2023
    • Avis de décès
  • Visit CMAJ on Facebook
  • Follow CMAJ on Twitter
  • Follow CMAJ on Pinterest
  • Follow CMAJ on Youtube
  • Follow CMAJ on Instagram
Letters

Revisiting the modern scientific physician

Olli S. Miettinen
CMAJ April 16, 2002 166 (8) 1014-1015;
Olli S. Miettinen
Department of Epidemiology and Biostatistics, Faculty of Medicine, McGill University, Montreal, Que.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Responses
  • Metrics
  • PDF
Loading

H. M. Finestone draws attention to the potential need in diagnosis to account for multiple factors and expresses the view that “it is not simply an ‘art’ that leads one down this line”: “rigorous scientific principles can still be used to achieve this goal,” and “in a unified fashion.” The implication appears to be that any given mode of thought or action in the practice of medicine either is art and thereby subject to being rhapsodic and individualistic, or is guided by rigorous scientific principles and thereby is more-or-less predictable and uniform across individual practitioners — even in the context of complex challenges. Insofar as this indeed was Finestone's idea, it needs to be juxtaposed to my corresponding presentation.

As I said, I used the term “art” in the Aristotelian meaning of “productive arts,” subsequently referred to as “mechanical arts” or “servile arts” (in contradistinction to “fine arts”).1 Nothing in the history of these arts, medicine among them, is inconsistent with the ideal of normative algorithms for setting gnostic probabilities in medicine; and in accord with this, I advocated the development and deployment of them. In these terms, gnostic probability-setting would be uniform across individual practitioners, in complex situations just as in simple ones. And what makes scientific gnosis essentially uniform even in the absence of normative algorithms is a shared commitment both to a theoretical framework that is singular by being rational and to the deployment of scientific knowledge, equally singular, in this framework. Principles are the foundation of scientific gnosis, but they are principles of the art of the practice of scientific medicine, not principles of medical science. I therefore do not think of them as scientific principles of practice but as principles of scientific practice.

Should Finestone use the term “art” in the same meaning as I do, inclusive of the context of scientific art, he likely would not make the point quoted above.

Sylvia and Richard Cruess raise some questions about the most important topic in my series of essays. Given their expertise in modern education in medicine, I appreciate their bringing up what they see as “issues of concern.”

Physicians are to meet, they say, society's expectations that they have “a fairly broad pool of knowledge, no matter how specialized they may be.” The Cruesses therefore ask how this would be accomplished in the early-specialization framework I advocate. Even in this framework, one specialty would be general medicine, with triage for referral to narrower specialties a core function in it. Once the public would come to know that other specialists are more narrowly educated, it scarcely would expect any fairly broad pool of knowledge — nor lament its absence — on the part of the physician practising only cataract diagnosis and surgery.

Related to this, the Cruesses ask how the medical common that I advocate2 differs from the core curricula in use at present. The latter are preparatory to the uniform licensure that now is “required of all physicians entering medical practice in Canada.”3 Its underlying philosophy is that whereas “the human body appears to react to … insults in a finite number of ways,” the examination is to cover “all of these ways” and, thereby, the “domain of medicine” in a comprehensive way.4 Thus the aim still is to educate, and to license, only all-purpose — complete — physicians. By contrast, the medical common I advocate encompasses only that which truly is of common concern across all of the differentiated types of modern practitioner. This obviously involves only a very small fraction of all of the ways in which the human body reacts to insults. The concept is profoundly different, and so consequently are the curricular implications.

As for “what process might be utilized to actually identify ‘the common,’” I'll just comment on pruning “the full clinical presentation list” of current concern in the licensing-oriented curricula.5 One option is to convene representatives of the various types of specialized practice of modern medicine and to have them go down that list, each identifying the topics that truly would be relevant for professional self-cloning. I would expect that none of the 127 main types of clinical presentation on that list would turn out to be relevant to all types of practice.

Olli S. Miettinen Department of Epidemiology and Biostatistics Faculty of Medicine McGill University Montreal, Que.

References

  1. 1.↵
    Miettinen OS. The modern scientific physician: 1. Can practice be science? [editorial] CMAJ 2001; 165(4):441-2.
    OpenUrlFREE Full Text
  2. 2.↵
    Miettinen OS. The modern scientific physician: 8. Educational preparation [editorial]. CMAJ 2001;165(11):1501-3.
    OpenUrlFREE Full Text
  3. 3.↵
    Medical Council of Canada. Objectives for the qualifying examination. 2nd ed. Ottawa: The Council; 1999. p. ii.
  4. 4.↵
    Medical Council of Canada. Objectives for the qualifying examination. 2nd ed. Ottawa: The Council; 1999. p. iv.
  5. 5.↵
    Medical Council of Canada. Objectives for the qualifying examination. 2nd ed. Ottawa: The Council; 1999. p. 1-5.
PreviousNext
Back to top

In this issue

CMAJ
Vol. 166, Issue 8
16 Apr 2002
  • Table of Contents
  • Index by author

Article tools

Respond to this article
Print
Download PDF
Article Alerts
To sign up for email alerts or to access your current email alerts, enter your email address below:
Email Article

Thank you for your interest in spreading the word on CMAJ.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Revisiting the modern scientific physician
(Your Name) has sent you a message from CMAJ
(Your Name) thought you would like to see the CMAJ web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
Revisiting the modern scientific physician
Olli S. Miettinen
CMAJ Apr 2002, 166 (8) 1014-1015;

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
‍ Request Permissions
Share
Revisiting the modern scientific physician
Olli S. Miettinen
CMAJ Apr 2002, 166 (8) 1014-1015;
Digg logo Reddit logo Twitter logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like

Jump to section

  • Article
    • References
  • Responses
  • Metrics
  • PDF

Related Articles

  • No related articles found.
  • Google Scholar

Cited By...

  • No citing articles found.
  • Google Scholar

More in this TOC Section

  • Hospital-at-home programs in Canada: challenges and pitfalls
  • Pitfalls of analyzing perinatal outcomes by health care provider
  • Author response to “Pitfalls of analyzing perinatal outcomes by health care provider”
Show more Letters

Similar Articles

Collections

  • Topics
    • Medical careers
    • Medical education, residency, internship

 

View Latest Classified Ads

Content

  • Current issue
  • Past issues
  • Collections
  • Sections
  • Blog
  • Podcasts
  • Alerts
  • RSS
  • Early releases

Information for

  • Advertisers
  • Authors
  • Reviewers
  • CMA Members
  • CPD credits
  • Media
  • Reprint requests
  • Subscribers

About

  • General Information
  • Journal staff
  • Editorial Board
  • Advisory Panels
  • Governance Council
  • Journal Oversight
  • Careers
  • Contact
  • Copyright and Permissions
CMAJ Group

Copyright 2023, CMA Impact Inc. or its licensors. All rights reserved. ISSN 1488-2329 (e) 0820-3946 (p)

All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association or its subsidiaries.

To receive any of these resources in an accessible format, please contact us at CMAJ Group, 500-1410 Blair Towers Place, Ottawa ON, K1J 9B9; p: 1-888-855-2555; e: cmajgroup@cmaj.ca

CMA Civility, Accessibility, Privacy

 

Powered by HighWire