MS & the Medical Arts

How many times have we heard about the Medical Arts?  A local college is named a Medical Arts school. A local doctor’s office is even in The Medical Arts Building, but I never gave that much thought.  For me the image of what is art is displayed in a museum, performed on a stage or even sold at a local craft fair.  But medical arts?

A recent discussion I heard, which was led by a doctor who was discussing Multiple Sclerosis and its diagnosis process, challenged me to think more about his point.  Yes, there is science involved in the practice of medicine but it rarely provides 100% of the answer for MS.

Images obtained by the Magnetic Resonance Imaging (MRI) machines are now done for almost all patients, but we know not all people with MS will have visible lesions.  Recent numbers suggest up to 10% of us will not have MRI evidence of our MS, and before we think that isn’t too many or such a high number, consider that a conservative estimate of the number of people in the world with MS is 2.5  million and 10% would be 250,000 people.  That is a lot of people without imaging science proving their MS, and must rely instead on their doctor’s interpretation.

There’s always the dreaded lumbar puncture (LP) to collect cerebral spinal fluid (CSF) to test for o-bands as evidence of MS.  But again, there are people who don’t have these markers in their CSF and that estimate is up to 15%.  That would be up to 375,000 people in the world of MS who don’t show this particular sign.  And we all know that there is no blood test to use to confirm MS.  So much for laboratory science in a test tube being a reliable tool.

I have to add that less than 20% of patients have problems with the dreaded LP headache and fortunately I was in the majority who had no after effects from the procedure. The name and the unknown spinal tap are much worse than the real procedure for most of us.

Often it comes down to the diagnostic skills of our neurologists and they then use the scientific evidence, if there is any, to support their diagnosis.  This premise that tests aren’t everything in medicine provided the basis for the discussion about the medical arts.  The word medicine comes from Latin, meaning the art of healing. The speaker elaborated on the intangible skills that physicians worthy of their degrees must possess and made his case for medical artists.

A skilled neurologist will employ skills of hearing, seeing and touching as part of the process, whether it is in the initial stages or a follow-up visit.  Listening is an art form - listening to a patient and hearing their history and responding with appropriate additional questions is necessary for every appointment.  The physician must be receptive to hearing the patient’s words and formulate a mental image of that history.   The doctor must also use observational skills to see how the body reacts to various stimuli.  What may seem silly to us, such as touching our nose with one finger, allows the neurologist to see much more. Tactile skills – the art of touch – are also an important part of the neurological exam and it takes trained hands to understand what they are feeling. The neurologist will visualize the history and the responses to exams to paint the diagnostic picture.

My doctor will probably never have an exhibit in an art museum because his patients would be impossible to frame, but nonetheless, he is a contributing member of the medical arts. Don't take me wrong - I still don’t think of my neurologist as Van Gogh or  even Rembrandt, who painted his Anatomy Lesson showing a human dissection in the Anatomy Theatre of the Guild of Surgeons in Amersterdam, 1632. Instead, he is more a Jackson Pollard  type of guy, but there is always an artistic approach to his painting my medical picture.

Wishing you well,


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