Talking, Touching, and Cutting: The Craft of Medicine

Abstract This article examines medicine from a craft perspective. Surgery—from dissecting to drawing tissues together—is easily recognized as a craft, traditionally learned by apprenticeship. Concern about patient risk has fueled a drive toward simulation education, where patients are represented by living or artificial stand-ins. The lack of context and variability afforded by simulation is a weakness, making medicine more like a production line than a craftsman's workshop. Elements of craft can, however, be introduced to simulation. People acting as simulated patients can add context and variation to standardized procedures and simulation technology can be fed with data that reflect real people's variability. But these measures cannot fully replicate authentic patientdoctor communication, which, more than instrumentation, truly defines medicine. Surgeons' ability to relate to people, as well as their skill with the knife, affects surgery's outcomes. Furthermore, much medicine involves no surgical procedures. Clinical craftsmanship based on talking to and touching patients is threatened by the ascendancy of modern diagnostic technologies. David Pye defines craft as a process, the quality of whose result is always at risk. Craftsmen respond to variability rather than uniformity. When doctors respect each person's uniqueness in the way they talk and the technical procedures they perform, they are preserving their craft against the logic of the modern production line.