Revisiting the modern scientific physician

The articles by Olli Miettinen on the modern scientific physician are thought-provoking.^{1,2,3,4,5,6,7,8} Miettinen writes well, even though it is sometimes hard to negotiate through his prose.

He correctly notes that “a genuinely scientific diagnostician” finds it necessary to identify “what really is the principal concept at issue — here that of the diagnostic probability to be quantified, ... the proportion in which the illness is present in instances like this ... .”³ The more I read the scientific literature and practise medicine, the more I realize that a diagnosis rests upon many issues that in turn can rest upon a multitude of other factors. Consider, for example, a patient with plantar fasciitis who is obese. She has foot pain that requires a specific diagnosis and treatment. However, her obesity contributes to the presentation of her pathophysiologic illness and is related to various psychosocial variables in her immediate and remote past. A “genuinely scientific diagnostician” therefore has to attempt to establish the roles of each of the contributing factors in the presentation of the primary diagnosis.

The truly modern scientific physician should be aware of the multiple factors that lead to a particular diagnosis and should incorporate them into his or her diagnostic and therapeutic regime. It is not simply an “art” that leads one down this line. It may be “farming” (to which Miettinen alludes early in the series¹), but it is “farming” of the human soma and psyche, in a unified fashion, that will enable the modern physician to make the appropriate diagnosis and determine the appropriate treatment. I believe that rigorous scientific principles can still be used to achieve this goal.

H.M. Finestone Physiatrist-in-Chief Sisters of Charity of Ottawa Health Service Ottawa, Ont.