Page:Carnegie Flexner Report.djvu/73

Rh The main intellectual tool of the investigator is the working hypothesis, or theory, as it is more commonly called. The scientist is confronted by a definite situation; he observes it for the purpose of taking in all the facts. These suggest to him a line of action. He constructs a hypothesis, as we say. Upon this he acts, and the practical outcome of his procedure refutes, confirms, or modifies his theory. Between theory and fact his mind flies like a shuttle; and theory is helpful and important just to the degree in which it enables him to understand, relate, and control phenomena.

This is essentially the technique of research: wherein is it irrelevant to bedside practice? The physician, too, is confronted by a definite situation. He must needs seize its details, and only powers of observation trained in actual experimentation will enable him to do so. The patient's history, conditions, symptoms, form his data. Thereupon he, too, frames his working hypothesis, now called a diagnosis. It suggests a line of action. Is he right or wrong? Has he actually amassed all the significant facts? Does his working hypothesis properly put them together? The sick man's progress is nature's comment and criticism. The professional competency of the physician is in proportion to his ability to heed the response which nature thus makes to his ministrations. The progress of science and the scientific or intelligent practice of medicine employ, therefore, exactly the same technique. To use it, whether in investigation or in practice, the student must be trained to the positive exercise of his faculties; and if so trained, the medical school begins rather than completes his medical education. It cannot in any event transmit to him more than a fraction of the actual treasures of the science; but it can at least put him in the way of steadily increasing his holdings. A professional habit definitely formed upon scientific method will convert every detail of his practising experience into an additional factor in his effective education.

From the standpoint of the young student, the school is, of course, concerned chiefly with his acquisition of the proper knowledge, attitude, and technique. Once more, it matters not at that stage whether his destination is to be investigation or practice. In either case, as beginner, he learns chiefly what is old, known, understood. But the old, known, and understood are all alike new to him; and the teacher in presenting it to his apprehension seeks to evoke the attitude, and to carry him through the processes, of the thinker and not of the parrot.

The fact that disease is only in part accurately known does not invalidate the scientific method in practice. In the twilight region probabilities are substituted for certainties. There the physician may indeed only surmise, but, most important of all, he knows that he surmises. His procedure is tentative, observant, heedful, responsive. Meanwhile the logic of the process has not changed. The scientific physician still keeps his advantage over the empiric. He studies the actual situation with keener attention; he is freer of prejudiced prepossession; he is more conscious of liability to error. Whatever the patient may have to endure from a baffling disease, he is not further handicapped by reckless medication. In the end the scientist alone