Positive Health Online

Originally published on https://www.activehealthcare.co.uk/literature/medical/267-common-sense-and-the-art-of-medicine

What has happened to plain common sense? Has the world gone mad? ‘Losing one’s mind’ seems to occur when all common sense flies out of the window. Is common sense truly the glue that keeps it all to gather, that keeps us sane? In which case we would want more of it, not less. But maybe we are losing so much of it because we no longer are aware of what it is. Maybe we are not aware that life does have a glue, a way of making it all stick together.

‘The philosophy of common sense’ is an 18th- and early 19th-century Scottish school of Thomas Reid, Adam Ferguson, Dugald Stewart, and others, who held that in the actual perception of the average, unsophisticated man, sensations are not mere ideas or subjective impressions, but that they carry with them the belief in corresponding qualities as belonging to external objects. “Such beliefs”, Reid insisted, “belong to the common sense and reason of mankind”, and in matters of common sense “the learned and the unlearned, the philosopher and the day-labourer, are upon a level”. Hence, it is a philosophy of life, just as any other, with similar value with regards to understanding life. The philosophy of common sense developed as a reaction against the scepticism of David Hume and the subjective idealism of George Berkeley, both of which seemed to stem from an excessive emphasis on ideas. This provided what seemed to the common sense philosophers to be a false start, leading from fundamental premises to absurdities. This false start stemmed from René Descartes and John Locke inasmuch as they gave to ideas an importance that inevitably made everything else succumb to them. In short, too much emphasis on ‘ideas’ (rationality), not enough on ‘perception’ (common sense).

What is this ‘common sense’ and how common is it? Common sense is not something people are born with; it's acquired through life experiences and learning from others. While babies may have basic instincts, the ability to understand cause and effect, which is a core aspect of common sense, is developed over time. This understanding is shaped by observing what works and what doesn't in various situations, and by learning from the experiences of others. Common sense is about one’s understanding of the causes and effects one observes and experiences in life. It's acquired through observation, experience, and social interaction, and is based on individual experiences and cultural contexts. A person's environment and upbringing significantly influence their understanding of what is considered common sense. So, if common sense is personal, what is so common about it? People living in similar circumstances will have similar experiences in life, which allows them to share a common understanding of how life is shaped. People living together in similar conditions have a common understanding of what life is about. Individual experiences that lead to similar conclusions and ‘common’ knowledge. As common sense is the result of observing life’s experiences, it is part of the basic structure of science, which is ‘the systematic study of the structure and behaviour of the physical and natural world through observation’. First to observe, before we begin to use rationality when the scientific approach enters the experimentation and testing stage. With this information, we can now understand how scientific development is a two-step approach: common sense, followed by rational thinking. Science requires common sense to start of the process of investigation.

But the ruling factions of the human world have chosen rationality and dismissed common sense as ‘primitive’, as ‘superstition’ and as ‘childish’, even though it has an official place in the philosophical world. Hence, everything in our world is built on rationality, on thinking, and is separated from the personal knowledge of experience that all living creatures possess. Knowledge devoid of common sense is no longer rooted in life itself. It becomes a virtual world in which every thought can move in all kinds of directions, unrestrained by the reality of life. That way knowledge, intelligence, becomes artificial. It can no longer be shared by human beings at a ‘sense’ level. We no longer have a shared experience level, a common sense level, in life. What the medical profession tells us about health – blood levels of specific molecules, chemical processes, actions of bacteria and viruses, interpretations of artificially produced images – do not have a direct link to experiences people have. Ideas like ‘being ill without knowing it’ are devoid of the reality of human experience, of direct observation, and consequently of science. The knowledge brought into the human world in this way cannot be shared and cannot become ‘common sense’. Approaching life’s balance from a rational rather than a common, a shared, point of view is lacking roots in a common, a shared, soil of life. Life is rooted within a shared nature and follows the natural rules, while thinking is rooted within the mind of one person, educated in thinking, not in observing. Nature is shared by all, is ‘common’ to all, while the individual mind is separating us from what binds us together, nature and natural life.

We all share the same structure of life, which provides us with a basic knowledge, a common sense of what that life entails. Rational thinking creates a picture of life as it is being organised within the rational mind of one person. Common sense joins the knowledge gained by a great number of people together, in order to create a broader picture of the reality of life, broader than one person’s conscious mind is able to embrace. Rational thinking creates visions of life without any common ground, but there is another strange aspect to this. Our entire medical system is such a rational thinking system. The analysis and conclusions of the thinking done in a very specific way and controlled by an authority, in this case ‘the medical world’, is then imposed upon the entire population. In common sense there is a shared experience we call ‘life’, even though every experience of that life is unique and different. In rational thinking there is mind separation, which is then used to implement one way of thinking, making it appear as if one idea holds absolute truth. In common sense we start from a joint venture, called ‘life’, and in rational thinking we try to impose ‘equality’ on life, a joint venture, disregarding what we already have in common. The idea that life must be ‘the same’ for everyone as opposed to everyone having similar experiences. How does common sense fair within the medical literature?

https://divisionsbc.ca/south-island/your-division/boardmembers/dr-mark-sherman

Dr Mark Sherman, author Evidence-based common sense?  – Family physician practising in Victoria, British Columbia (Canada), and the coordinator of the Community Health Cooperative of Victoria initiative. Published at PubMed Central in 2008

Evidence-based medicine (EBM) is the popular term, all too loosely used, to validate claims made by various health practitioners, educators, authors, researchers, and pharmaceutical company representatives about the benefits and limitations of drug use and clinical management of disease. According to Marchevsky’s Critical Appraisal of Medical Literature, EBM aims to “de-emphasise intuition, unsystematic clinical experience, and pathophysiological rationale as sufficient grounds for clinical decision making”. The reality of life is that bias, competing interests, and misinterpretation (or manipulation) of data are all rampant in our medical literature and continuing medical education. It is thus the important responsibility of the clinician reader to interpret such medical literature with a discerning eye, a healthy scepticism, and both feet firmly grounded in their own common-sense intelligence. That’s right, I said it – common sense. Perhaps our faith in EBM as the ‘end-all, be-all’ authority on best practice is so absolute and exclusive that it blinds us from our own experience and intelligence. We do not live or practise in a laboratory, nor within the boundaries of double-blind, placebo-controlled trials. We live in a real world with patients who are also people. We are the inheritors of traditions and histories in medicine from which we should have grown and learned. Placebo effects, human bias, research politics, competing interests, and subjective interpretation are plain realities of any research and can easily blur definitive conclusions.

https://ruraldocalan.substack.com/p/evidence-based-medicine-vs-common

Evidence-Based Medicine vs. Common Sense by Rural Doc Alan, published in March 2024

There was a time when physicians could hospitalize patients they thought needed to be hospitalized. We didn’t necessarily have a specific diagnosis in mind to admit them. In fact, we needed to admit them to determine a diagnosis. We knew they were sick, but needed to be able to determine precisely why. Patient hospitalization was for the specific purpose of getting the correct diagnosis and the correct treatment. We could put patients in the hospital just because we didn’t know what was wrong with them. We are now face-to-face with the absurd idea that we can’t hospitalize somebody without a diagnosis and that if we guess at a diagnosis, we are setting ourselves up for the accusation of fraud. I remember before we had evidence-based medicine. I remember when we were allowed to have common sense, and more importantly, to use it. I remember a time when we would NOT be penalised for telling the truth or for thinking too much.

The hallmark of a good physician is the understanding that each patient is different. The basis of a physician’s medical expertise resides in recognizing every patient as a case of one. In medical research, the case of one is disparagingly labelled anecdotal and not to be counted. In the actual practice of medicine, every patient is a case of one, as Hans Duvefelt describes so well in his Substack post “Art and Archetypes in Medicine”.

https://journalofethics.ama-assn.org/article/limitations-evidence-based-medicine-applying-population-based-recommendations-individual-patients/2011-01

The Limitations of Evidence-Based Medicine: Applying Population-Based
Recommendations to Individual Patients – By Joshua J. Goldman and Tiffany L. Shih Jan 2011, American Medical Association Journal of Ethics

In the last three decades, evidence-based medicine (EBM) has become the gold standard for clinical practice. In fact, physicians who forgo evidence-based recommendations in favour of treatments supported by personal experience or undocumented recommendations make themselves more vulnerable to liability and subsequent indictment and may even appear arbitrary or unscientific.

Tonelli – ‘The Philosophical Limits of Evidence-Based Medicine’, published in Academic Medicine in 1998, Mark R. Tonelli MD, MA, – defines evidence-based medicine as a twofold concept. First, EBM is an optimal method for developing and describing population-based medical evidence – what he calls ‘a school of medical epistemology’ (= the critical study of the scientific principles that support clinical practice). Secondly, EBM ‘attempts to describe a clinical practice centred on evidence derived from clinical studies’. Tonelli argues that the shortcomings of EBM arise from presupposing the validity of that epistemological framework. As he sees it, EBM does not satisfactorily integrate clinical experience, patient and professional values, pathophysiologic rationale, and expert opinion into treatment. He points out three limitations of EBM.

• Practical Limitations – The concept of ‘evidence-based’ (as opposed to, for example, experience-based or physiology-based medicine) is predicated on giving general priority to knowledge derived from clinical research. For one thing, data sources are often called into question because the companies that stand to gain the most from an intervention’s success fund the studies that investigate the interventions. For another, rare diseases that affect small patient populations have little clinical data to rely upon. And no matter how many studies are done or how strong the evidence is, every variable in the circumstances of each patient cannot be accounted for;
• Philosophical Limitations – Though clinical trials cannot quantifiably assess the effect on outcome of either a patient’s attitude and motivation in obtaining treatments, or assistance and support from family, it is easy to see that these variables may affect the patient. Furthermore, not all non-quantifiable variables are always as clear-cut as we would like them to be. Happiness and other emotional attributes have been scientifically linked to hormonal changes that affect the immune system. In an attempt to form a universally relied-upon bank of clinical knowledge, the EBM movement has encouraged more ‘objective’ decisions that neglect non-quantifiable individual variations;
• Ethical Limitations – Another pertinent aspect of the gap between research and practice is that ‘no amount of empiric data can ever tell us what we ought to do in any particular situation, as conclusions regarding what ought to be done are value-based’.

Our revered evidence-based medicine – rationality above all else – not only has serious limitations in providing the outcome a particular patient requires, but it also fails to critically evaluate its own performance rating. Implementing a point of view that life is the same for everybody results in the observation that the outcome of the intervention isn’t always what is required for the individual. Furthermore, the system refuses to allow any other approach for achieving health to enter the playing field. The reality of life not being a rational process, not being dominated by reason and logic, is kept far away from the public’s mind. The medical authority crushes the ‘common sense’ of life for the lack of scientific support, while at the same time no scientific, critical, approach to the evidence produced in the real world – a world of human bias, research politics, competing interests, and subjective interpretation – is accepted. Thinking, not rooted within life itself and its experiences, separates us from our living roots. We no longer share ‘common’ experiences that form the basis of our thinking. Instead we accept another person’s thought to replace our own common sense knowledge. This is a dangerous development as it not only separates us from our fellow human beings, but it also separates us from the roots we have in life itself, where we create personally experiences. When we no longer are allowed ‘to know’ things through personal experience but instead we have to accept knowledge, injected into our lives not from nature but from another human being, we become separated from life itself. We will lose our personal understanding of life, the knowledge we have gained together directly from our human experiences, to be replaced by a knowledge, sprung from the fantasy of one specific mind.

And besides common sense, the medical profession has wiped away something else from its history books. What has happened to the art of medicine? Where can we find it, and what does it mean? The origin of the phrase can likely be traced back to one of the most famous ancient physicians, Galen, who wrote ‘Ars Medica’ (‘Art of Medicine’) in 100 or 200 BC. In his treatise, Galen describes mental properties and argues his hypotheses based on animal dissections. Galen was more likely referring to the technical skills and the craft that physicians employ to make discoveries and treat patients. In the modern lexicon, the phrase ‘the art of medicine’ has come to define the so-called soft skills involved in treating patients – abilities that we learn in our doctoring course. Doctoring focuses on both physical examination of the patient and interviewing skills as well as on building rapport with patients. This is how I’ve often heard the phrase employed, especially while talking about the talent required to be an effective and trustworthy physician. These soft skills, such as empathy, listening, and attentiveness, foster the doctor-patient partnership, an alliance highly touted by medical schools.

This is strange! Interpreting ‘the art of medicine’ as meaning practical skills and being empathetic does not reflect the essence of the word ‘art’. Art is defined as the expression or application of human creative skill and imagination. Learning practical skills and interviewing skills doesn’t define you as ‘an artist’. Creativity is defined as the ability to make or otherwise bring into existence something new, whether a new solution to a problem or a new method. Hence, when all doctors are forced to follow ‘the protocol’ it certainly does not allow any room for creativity. We can state with confidence that following a prescribed protocol does not constitute ‘an art’. And imagination is the ability to form a picture in your mind of something that you have not seen or experienced. This seems like a useful thing to do with regards to medicine. In spite of the general consensus that medicine must be ‘objective’, ‘quantifiable’ and ‘evidence-based’, the introduction of a bit of imagination when pondering a specific health problem in a specific person would endorse the fact that we do not know everything about diseases and about life. So, allowing your mind to create a picture of something you haven’t seen before – in fact, it sits nicely alongside ‘thinking outside of the box’ – potentially widens the scope of your approach to the problem. Where is the creativity and imagination in the way medicine is practised today? It may appear as if the entire modern medical construction is a creative expression of the wild imagination of an investor, a thinking mind able to creatively overrule simple observations and has managed to present his enforced ideas as 'common sense'.

The Oath of Hippocrates presents cryptic, yet inspiring, words that spoke to the ethics and spiritual dimensions of being a physician. Initiates to the medical profession swear to ‘guard my life and my art in purity and holiness’. More quotes from other great humanitarian scientists such as Sir William Osler, Albert Schweitzer, Oliver Sacks, and even Albert Einstein filled the gaps within the pages of the medical textbooks, such as Principles of Internal Medicine by Tinsley Harrison. The art of medicine is as much about the doctor as an individual as it is about being a competent, a skilled, doctor. Sir William Osler, the Father of Modern Medicine, said, “The good physician treats the disease; the great physician treats the patient who has the disease”. Physicians who practise an artful brand of medicine are destined for that Oslerian transformation to healer, where they become no longer the dispenser of therapies but rather the embodiment of therapy. Medicine no longer becomes a living for great physicians but rather a way of living. Unfortunately, making the quantum leap to that higher echelon of medicine seems impossible in today's health care environment. The landscape in which medicine is practised today presents a moral hazard for most practitioners. Sadly, most of them and their teachers are totally oblivious to this situation. The corporatisation of medicine dictates the delivery of health care; an individual's expression of their art and hence, the transformative path to becoming the physician-artist and healer is blocked.

The art of medicine is much more about using the experience and the knowledge of the individual doctor then it is about the academic knowledge of medical research. It is much more about the healing skills of the doctor then it is about his rational skills. Healing skills are a rational way of trying to solve a problem, in this case a health problem, but rooted within life itself, within the personal ‘common sense’ of the healer. Rationality must be subservient to the root knowledge of life itself. Elevating rationality above common sense creates a dissociation between the reality of life and our mind picture of it. No longer being aware of this dissociation results in us living in a fantasy world, the fantasy of believing all of life is rational. Life seen as a mechanical machine that we can manipulate easily! And I find it amazing that this is still the way the medical profession is approaching life, in an era where this mechanical view of the universe, Newtonian physics, has been superseded by quantum physics, where life and the universe is known to be an energetic soup. Hence, creating a mechanical rational approach to life, and living accordingly, is indeed nothing more than fanciful, delusional and misleading. And the medical profession is leading the way, dragging in its wake a distorted view of what science is, in the sense that observation and personal experience has been removed from how science is presented to the public. Without the observation of personal experiences there can be no science. Without common sense there can be no healing medicine. When one removes the roots of a plant from the soil it naturally grows in, the plant no longer lives its natural life, no longer responds in its natural way. Humanity, being human, is on death row without its root connection.

Acknowledging that we don’t know everything creates room for ‘new possibilities’. It’s a maybe, but we keep it in mind. Not allowing people to colour outside the lines, forcing a strict adherence to the protocol without any room for deviation, creates a sense of absolute truth. And that, most definitely, is a lie. There is no absolute truth! But by suffocating all other possibilities we kill the creativity, we kill the art of medicine, we kill common sense.

Where is the Life we have lost in living?

Where is the wisdom we have lost in knowledge?

Where is all the knowledge we have lost in information?

 T.S. Eliot - June 2025

Copyright Acknowledgement

Originally published on https://www.activehealthcare.co.uk/literature/medical/267-common-sense-and-the-art-of-medicine