World War II

“Medical care is only aided by science; it is not a science itself. The practice of medicine consists of applying scientific medical knowledge to individual patients with unique symptoms and complaints. . . . In the 1950s, when editors speak of ‘scientific medicine,’ they are thus proud of the availability of ‘scientifically’ generated medical knowledge and technology. The notion of ‘scientific medical practice’ is seldom used, and when it is it rarely means anything other than this presence of scientific knowledge (Berg, 441, 442). . . . In this early postwar discourse, then, medical practice is seen as the artful application of medical science (444). . . . The origins of the problems of medical practice lie in the existence of restraints external to the practice of medicine itself: the fight is against corruption seeping in at the margins. Once these restraints are removed, once governmental control is diminished and more high-quality physicians are trained, the practitioners’ art can thrive undisturbed” (445-46). . . . [Only in late 1960s and 1970s, with the works of Alvan Feinstein and Lawrence Weed, does a different rendering of medical practice emerge:] “Here, medical practice is not primarily the application of a science located elsewhere: now, the practice of medicine itself is a scientific activity (449) . . . . inadequacies in medical practice reflect the lack of “’the scientific qualities of valid evidence, logical analyses, and demonstrable proofs’” . . . the solution lies in a new, standardized type of medical file, i.e., the ’problem-oriented record’ that will permit the physician to act scientifically (450) . . . “Standardization now includes medical procedures and is seen as a fundamental prerequisite to medical practice as a scientific activity in itself. It is a sine qua non for the full-blown development of this new science” (451). . . .In the 1970s and 1980s, a new discourse arose in which the ‘scientific character’ of medical practice became a thoroughly individualized notion. . . . the scientific status of medical practice was redefined as a feature of the physician’s mind” (452). . . . Within this cognitivist reconfiguration of the shape of medical practice, we see two different views competing for attention. Based on the metaphor of the information processing computer, one approach views the physician as mentally manipulating nonquantitative symbols: the physician follows the hypothetico-deductive method in solving a patient’s problem. The other approach views the physician as a calculating computer, arguing that physicians intuitively combine probabilities” (456).