CLINICAL-PRACTICE - BETWEEN ARISTOTLE AND COCHRANE

Health and disease consist of amino acids and self image, cell membran es and human ideals, muscles and politics. Only to a limited extent ca n clinical practice be based on science. It can never be carried on in isolation from political and cultural forces that influence patients' health behaviour. Evidence-based medicine is essential but not suffic ient. A continuous relationship with patients is a conditio sine qua M on for general practice. The general practitioner must be a master of pragmatic medicine. Rationality. the dominant modern trend may be dang erous for patients and doctors: (1) advances in technology can give pa tients and doctors the illusion of mastering the universe; (2) patient s complain of being treated like bio-machines, without human touch. An other symptom of modernity is the decline of religion. But patients an d doctors are by no means rational beings. God, destiny and hope are r eplaced by modern medico-scientific megalomania. Modern medicine is al so strongly influenced by commercialization and invasion by bureaucrat s. Instead of becoming a biomedical robot, the general practitioner mu st learn to value the Aristotelian concept of phronesis. It means prac tical wisdom and can only be gained by personal experience; a form of learning by doing. Good clinical practice cannot come from science alo ne, or from personal experience alone. It is an amalgam of scientia an d phronesis.