In a famous play by Goethe, a doctor is accused of practicing quackery. At his trial, he defends himself by stating that the practice of medicine is as much an art as it is a science.

Even with the extraordinary explosion of scientific, technologic and pharmacologic advances in the past 25 years, this is still surely true. The miracle medicines, unbelievable surgical implants and nearly magic diagnostic tools have not quelled our patients' increasing desire for complete resolution of their pain and 100 percent improvement in their physical condition.

Society's general perceptions of life have changed. Death and disability were once accepted as part of the life continuum. Many people with obvious disabilities functioned in the post-World War II era. Yet in the 21st century, people's expectations and perceptions about their physical selves are more demanding. They are not prepared to accept less-than-perfect outcomes from treatments, often blaming their physicians and seeking restitution.

In the interest of patients who often verbalize their fears and disappointments at our inability to solve their problems, we must become more masterful artists. A successful artist captures his audience and brings it along on a shared endeavor. Our patients need to be brought along on the fascinating journey of our scientific quest. Often patients do not grasp the complexity of their pathologies, so unless we dialogue and make them privy to our reasoning, their expectations will remain unfulfilled.

The demands of modern medical practice with managed care dictating the number of patients seen and the use of scientific advances depending on cost have made meaningful, time-consuming conversations between physician and patient difficult. Complicating matters further are unrealistic patient expectations, fueled by nearly constant TV ads touting the wonders of new drugs and procedures. The result is that harried physicians, wanting to assuage patients, may find it easier to prescribe the new pill or offer some procedure, without patients fully understanding the possible shortcomings and complications.

However, sometimes it's best to do nothing except be supportive and explain the reasoning behind that decision. In the British Medical Journal, Robert Hutchison said it best:

From the inability to let well alone:

From putting knowledge before wisdom, science before art and cleverness before common sense:

From treating patients as cases and from making the cure of the disease more grievous than the endurance of the same, DELIVER US.

Robert Jaspan, MD, is editor for the Riverside County Medical Association. He is a retired orthopedic surgeon and a past president of the RCMA.