Clinical medicine and the quest for certainty

Orthodox medicine works in a scientific framework which often discounts knowledge arising outside biomedical models and the statistical means by which these are tested. Alternative medicine cannot meet these standards because it is holistic and individual in its orientations toward the understanding and treatment of human illness. But in fact the dominant model also has problems with surgery and other areas such as family practice as sub-disciplines where individualised caring solutions are important. These prominently include areas in which wider social and economic concerns directly impinge on health care so that we need a more liberal attitude to medical knowledge and discovery. I suggest that this wider conception is more in keeping with the Hippocratic ethos as a whole and with the idea of a healing praxis. Because our aim as doctors and health care professionals is to help people, and our knowledge is directed towards furthering this end, medicine is a practical science not able to stand apart and build theories in detached contemplation from within the ivory tower of the academy. However the practicality of medicine and the assurance needed to poison people or inflict grievous bodily harm in an effort to help them often puts a premium on certainties in our thinking about clinical medicine before the scientific basis for such certainty has been established. Therefore, hand in hand with the professional calling that is health care, goes the need for a certain style of belief in what one is doing and its ultimate rightness. This leads to an almost unique profile for medicine among the sciences. (C) 2003 Elsevier Science Ltd. All rights reserved.