What is thing called medicine?

It was reading Herb Simon’s ‘Sciences of the Artificial’ that woke me up what some professional schools had in common. I even wrote a piece in PLoS Medicine arguing that medicine is more engineering than science (‘The problem with academic medicine: engineering our way into and out of the mess’). And I think I called it right. But the parallels between medicine and many other other traditional professions is large. I am thinking law, architecture, teaching, and engineering. These are all design sciences, or since I sort of object to this use of the word science, design domains. One of the reasons medical education — and to a lesser extent medicine is in such a mess — is the way that we have failed to grasp this distinctions. I wrote last year:

Simon was a genuine — and it is an overused word— polymath, and at that time I was ignorant of his many contributions. His work ranged through business administration, economics (for which he was awarded a ‘Nobel’ prize), cognitive science, computing, and artificial intelligence. But what fascinated me most was the content of his most famous book, ‘sciences of the artificial’. In this work Simon set out to unify and provide a common intellectual framework for many human activities that involve creating artefacts that that realise a purpose of our choosing. Unlike our dissection of the natural world, whether that be identification of a gene for a disease, or a virus that causes a human disease, Simon was concerned with how humans build artefacts. In particular how do we navigate search spaces that are large, and where uncertainty is all around, and where there may be no formal calculus to allow us to fire across boundaries. He was thinking about thinking machines of course, but quite explicitly he was concerned with the professions, architecture, law, and of great interest to me, medicine and teaching and learning. I was hooked.

One of my favourite quotes is from Simon’s ‘Models of My Life’

More and more, business schools were becoming school of operations research, engineering schools were becoming schools of applies physics and math, and medical schools ere becoming schools of biochemistry and molecular biology. Professional skills were disappearing from the faculties.…they did not fit the general norms of what is properly considered academic. As a result, they were gradually squeezed out of professional schools to enhance respectability in the eyes of academic colleagues.

So I warmed to an article titled ‘Building a future for engineering’ in the Times Higher, linking to a Royal Academy of Engineering’s 2014 report, ‘Thinking Like an Engineer – Implications for the Education System’. I have not read all of the latter, but I warm to the phrase in the THE, referring to the report: ‘Even more fundamentally, engineering is a set of habits of mind’. Clinical medicine is more engineering than science.