Mystery in surgery

We noted in Chapter 1 that claims to objectivity have characterised medicine more and more since the Enlightenment when empirical science began to play an increasingly dominant role in clinical practice. This process accelerated beyond recognition during the second half of the twentieth century and with the advent of evidence-based medicine it would seem that we have almost arrived at a place where the knowledge and expertise of the practitioner has displaced the narrative of the patient at the heart of clinical practice. The doctor as expert on the patient’s condition exercises skill and clinical practice has become a series of techniques applied to the dysfunctional body to restore it to functional normality. David Greaves refers to this historical shift as a disappearance of mystery in medicine and infers that, despite the advances which science has afforded clinical practice, something very important has been lost in the process.1 This would seem to be true above all in the practice of surgery where technique clearly plays a more prominent role than elsewhere in medicine. If ever the human condition is transparent to a practitioner, it would seem, it is surely to the surgeon who uncovers the problematic features of the body and deals with them before his very eyes. Mystery, it would seem, is never further away in clinical practice than at the operating table.