‘THEORY AND PRACTICE’
CAERS SUBSTACK ARTICLE #35
I have written before about the Greek concepts of ‘episteme’, the academic way of knowing, and ‘techne’, the practical way of knowing (Article #25 ‘Expertise’). Respectively, these can be referred to as theory and practice. Do they yield different results? If so, which is better? Maybe that famous philosopher/baseball player, Yogi Berra, shed some light on this when he quipped: ‘In theory there is no difference between theory and practice; but in practice there is’.
It is likely that most of us have noticed that there is a difference between the two. I certainly did when I entered into medical practice. The lectures I had attended and the exams I had written during medical school approached medical problems from a very objective and impersonal perspective. Cases were presented in a very factual and straightforward way, devoid of any feelings, inconsistencies or real-life drama. No one was really suffering or dying; they were purely mental exercises.
But that was not at all what practice was like. The ‘facts’ were not so readily available: memories are inaccurate and the signals can be hard to distinguish among the noise. But far more troublesome was the fact that I was dealing with real people who really were suffering, and sometimes dying.
We are all wise and brave when everything is still theory, but when the rubber meets the road that can all change in a heartbeat. Proficiency at exam writing does not translate automatically into proficiency in medical practice. Equally, as a potential patient we may say that if ‘x’ happens to me, I will never opt for treatment ‘y’. But when ‘x’ does happen, ‘y’ can suddenly be worthy of serious consideration. Many of us make living wills to guide caregivers if we become incapable of making our own decisions. However, it is surprising how often these documents are not followed to the letter because the future is hard to predict, probabilities change and risk tolerances vary with time and circumstance.
As a family doctor I was more about doing than lecturing; more a mechanic than a professor. And as a generalist I was an expert in nothing; my perspective was broad and shallow, not narrow and deep like a specialist. Both ways of knowing have their challenges and rewards. Perhaps surprisingly, one of the major differences between the two is that generalists tend to be more comfortable with uncertainty. They often rely more on intuition, the right side of the brain, than the purely logical left part of the brain. That often is a result of a tendency to more experiential learning than academic learning. Street smarts versus book smarts.
I suspect that the same holds true in many fields of endeavour. Mothers have known for millennia that breastmilk is still the best thing to feed infants; it took a long time before experts had academic ‘proof’ that such was the case. Grandmothers have known for centuries that ginger tea helped to settle nausea, long before pharmaceutical companies marketed it.
It strikes me that since the scientific revolution we have come to focus far more on logical skills than practical skills. We elevate those who work with the left side of their brain over those who use more the right side: engineers over mechanics, specialists over generalists, white collar over blue collar.
Have you seen any evidence of this during the pandemic? Do you think a better balance might be in our best interests? Did we listen enough to people on the ground, on the frontlines? When a pregnant woman expressed her intuitive concern about taking an experimental vaccine that had not been tested during pregnancy and involved gene therapy, did we respect and trust that she was doing what she thought was best for her baby? During the 1960’s many mothers were told by experts that the formulas they developed were better than breastmilk, and so a generation of us were not breastfed (and I was among them).
As Yogi said, theory and practice do not always align. And that is a good thing, because it means we need them both. But it may not always be wise to have one always dominate over the other. As with so many things in life, finding the right balance is difficult but usually worth the effort.
J. Barry Engelhardt MD (retired) MHSc (bioethics)
CAERS Health Intake Facilitator