Theoretical knowledge of the science or the practical intricacies

What is more important in practicing medicine, the theoretical knowledge of the science or the practical intricacies and skills?

I must admit that, at first glance this question seems to fit into the category of "which came first, the chicken or the egg?" -- perfect for stimulating philosophical discussion, but ultimately unanswerable.( just debatable--Ha..Ha..Ha..) However, it is a question that is discussed frequently among physicians and while a bit philosophical is important to address.



While reminiscing about classmates in medical school, one person recalled a teenager who had started medical school in the class behind her and the awe and hype that had surrounded him. This prompted a rather passionate discussion about kids in medical school. The general consensus was that despite the likelihood that this kid would do better on his board exams than anyone else we knew, none of us would feel comfortable with him as our doctor or as a family member's doctor. Our concern stemmed from our belief that other life skills and experiences influence our success as physicians, not just an IQ.

Being an effective physician is a balancing act. Patients may look sick but be healthy or look healthy and be sick or anything else in between. Some will lie, exaggerate, and abuse the system; others will avoid seeking care because of fear or cost or apathy. Most importantly, none will enter your practice environment with a big arrow pointing to the problem or with a list of symptoms straight out of a textbook. Sifting through stories for truth is a skill that we all learn in our personal and professional lives. Assigning importance to various pieces of the puzzle comes along with that skill. Identifying what is actually wrong at times depends very little on textbook knowledge.

This is not to say that just being able to recognize a problem, or the lack of a problem, is enough. Once you've broken through the glossy coating and identified the truth, you then must know how to treat. This is where the textbook comes into play. If you haven't studied, passed your boards, and read the current literature, you will not be able to effectively and accurately address the problem at hand. In fact, attempting to do so without the appropriate knowledge is more than a disservice, it's a violation of your oath.

As much as we don't like to admit it, there's probably a little nerd in all of us. We study hard, but we were all pretty smart to begin with. We all can probably remember Horner's syndrome, though we don't remember who Horner was. At one point we all passed organic chemistry, memorized the Krebs cycle, and identified histologic slides. Learning this theory has used quite a few neurons, and at the time, our professors told us it was important. Now, while practicing medicine, we all know it wasn't a complete waste of time (although there are some useless factoids stuck in my brain that I wish I could purge for other things). We also know, however, that all this knowledge can never be enough. Medicine is an art as well as a science, and we have to function well within both worlds to be effective...