The good-hearted and the clever: clinical medicine at the bottom of the barrel of science

Clinical medicine, the work of listening to and curing the ill or disabled person, is falling progressively into scientific disrepute. Biomedicine and public health dominate the scientific and cultural scene. These disciplines may be seen as variants of the reductionism scientific model. From an extremist perspective, this overshadows the reality of phenomena as a whole, and imposes a never-ending search for causes within increasingly smaller parts. The model has tremendous efficacy where parts can be repaired, yet it fails to come to face with whole-person problems like psychiatric illnesses, acute and chronic disabilities, ageing problems and terminal conditions. The medical model should recuperate its original scientific high ranking, mostly through innovative teaching models, starting at the academic level. It is contended that (a) research should respect the specificity of the medical model; (b) this, in turn, must remain within the boundaries of the contemporary scientific model; (c) upgrading cannot be done simply by adding ethical constraints or, claiming that Medicine is "more than science"; (d) advanced research instruments and methods should be borrowed whenever possible from the social sciences; (e) inductive reasoning, research methods, teaching and psychological skills should become explicit components of the clinicians' curriculum; and (f) medical training should provide that there be early branching into biomedical, clinical and population health specializations. Clinical specializations should be organized into areas sharing the level of interpersonal relationship rather than technical peculiarities.