The current fashion in medicine is to label things as either “evidence based” or “not evidence based.” We use these labels to describe treatments, diagnostic tests, public health policies, and even people. This dichotomous worldview, however, fails to capture the nuance of the medical landscape. The use of evidence to drive medical decision making should be lauded, but there will always be more to providing proper healthcare than reading statistics in a journal or following clinical algorithms. The shorthand we use to convey this reality is “the art of medicine.” I think a better analogy would be “the architecture of medicine.” After all, proper medical care has a structure built around a clear purpose: to improve the health of the patient. It is engineering with flair.
At the same time, an unyielding focus on utility and regulatory compliance is the cause of many of contemporary medicine’s vivid eyesores: the proliferation of rigid yet contradictory clinical guidelines; blunt point-of-care applications; and electronic medical record systems usually described as a hurdle rather than as a tool. Each of these engineering innovations promised medicine a new evidence based foundation but have instead been introduced without considering the longstanding traditions our community holds dear. This contradiction in today’s medical practice, its simultaneous focus and myopia, is reminiscent of the brutalist architecture movement.