The nature of the profession

Catharsis: On the Art of Medicine Andrzej Szczeklik; University of Chicago Press; 2005; 161 pp $20.00 ISBN 0-226-78869-5

Why is a book on the essential art of medicine still getting rave reviews? Andrzej Szczeklik, a Polish cardiologist and scientist, is no stranger to high tech, life-saving interventions. But he is also familiar with the limits of science and how these limits affect physicians and their patients.

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Photo by: University of Chicago Press

The problem with medicine as pure physiology, as a strictly empirical science, is that its objective — human health — resists any straightforward definition. Health is never construed as “health alone,” an idealized pristine state of inertia, a lack of disturbance, but rather as something that is acquired and lost in a continual process through the course of one's life. If health is an active process in which individuals participate, does it not follow that adversity or sickness is somehow related? Szczeklik connects these life situations using the Platonic myths of Fate and Necessity, and weaving case reports and current scientific developments into philosophical themes relevant to medicine — the pursuit of healing (the Philosopher's Stone) and the universal experiences of Suffering and Death. The result takes us somewhere inaccessible to science: the worlds of values, art, faith and other individual phenomena (page 139).

Balancing titans, heroes, medical history and individual accounts is tough to pull off, but the author manages a unique, even poetic synthesis (with only minor imprecision around the emerging science of cloning). Catharsis holds together and is attractive to physicians because it grounds ideas in the concrete relationships between doctors and their patients. The ancient relationship between the suffering individual and his or her physician revolves around an understanding that we are always something more than the single meaning the surrounding world (including medicine) tries to impose on us, the world of simplified generalizations and reductions, the world of clumsy divisions (page 85). In Einstein's words: “Living matter and clarity are opposites — they run from one another” (page 136).

This book is itself a chimera, more than an erudite collection of mythology, history and anecdote. It is a thoughtful expression of a life dedicated to medicine, a tension between the need for science to identify reproducible patterns while addressing the art of the singular. As Szczeklik, reaching the end of his own successful career reveals, “When the years start to add up, time goes ever faster and the shadow line is far behind us, we start to feel a longing to understand the nature of the profession that has swallowed up our life.”