
Çok Değerli Meslektaşlarım,
Daha öğrencilik hayatımın başında duyduğum, çok etkilendiğim ve hep öyle olması gerektiğine inandığım bir “TIP” tarifi vardır: “TIP BİLİMİ VE SANATI” der. Gerçekten de bizler “BİLİMİ KULLANAN SANATKAR”larız. Ne yazık ki günümüzde bu tanımı OLMAMIZ GEREKEN diye düzeltmek gerekiyor.
Dünyanın en eski mesleklerinden biri olan hekimlik, aslında insanoğlunun gereksinimlerinden doğmuş bir sanattır. Doğaldır ki insanın yaratıldıktan sonraki ilk gereksinimi ve refleksi, yaşamını devam ettirmek ve sağlığını korumak olmuştur. Sanat olarak ortaya çıkan hekimlik, bir yandan usta – çırak ilişkisi ile deneyim, bilgi ve yeteneklerin nesilden nesile aktarılmasını sağlayan bir mecra olmuş, diğer yandan ise bilimi giderek artan şekilde kullanarak sınırlarını genişletmiş, uygulama yöntemlerini ve kalitesini geliştirmiştir.
Günümüzden 50 yıl öncesine kadar hekim denince akla, elinde bistürisi ile cerrah ya da elinde klasik doktor çantası, kulağında stetoskopu ile hastayı muayene eden kasaba hekimi gelirdi.
Hekim – hasta ilişkisinin birebir yürütüldüğü ve işin sanat tarafının ağır bastığı bu dönemden bilimin giderek daha fazla kullanıldığı yıllara doğru ilerledik. Bu süreçte, hekimlik ve tıp adına çok büyük ve olumlu değişiklikler olmakla beraber gözden kaçan bir gerçek bugünü hazırlamaya başladı. Bilimsel gelişme teknoloji ile, teknoloji sanayi ile, sanayi de ekonomi yani para ile yakın bağlantılı idi. Sonuçta sadece bistüri, makas, steteskop, muayene giderli, sanatkarlık ağırlıklı hekimlikten günümüzde belki de savaş ve elektronik kadar büyük paranın döndüğü dev sağlık sanayiine geçildi. Tüm dünyadaki büyük kapital yönetimleri bu kadar büyük bir pastanın paylaşımının hekim ağırlıklı olamayacağına karar verdiler.
Bunun anlamı, sağlıkta hasta – hekim ilişkisinin, hasta – sağlık sistemi ilişkisine dönmesi idi. Amaç, hastaların, en özellikli tedavilerde bile ismi ve kişiliği ile birebir ilişkide olduğu bir hekimi değil elektronik ortamda randevu alıp, sekreterlerle işlemlerin yürütüldüğü, her tür laboratuvar tetkiki ve görüntülemenin sistematik olarak yapıldığı, hesap ve ödemelerin sağlık kuruluşu – sigorta kurumu arasında halledildiği kurumları seçmesini sağlamaktı. Ustanın sanatını dikkate alarak yapılan tercihlerden sistemin rahatlığı, teknolojik etkileyiciliği ve görünürdeki ucuzluğu (!) dikkate alınarak yapılan tercihlere dönen hekimlik de giderek sanattan uzaklaşmaya başladı.
Tüm ayrıntıları hesaplayarak kurulan mükemmel elektronik sistemler, birçok yerde olduğu gibi sağlıkta da sorunların büyük bölümünü halletmeye yeterlidir. Ancak unutulmamalı ki tanrının en mükemmel ancak bir o kadar da karmaşık eseri olan insan, sadece hesaplanabilir sistemlerden oluşmuyor. İnsan, hayatını yöneten ve özellikle sağlığı bozulduğunda daha da önem kazanan bir duygu bölümü de içeriyor. İşte tam burada hekimliğin sanat yönünün ne kadar önemli olduğu gündeme geliyor. Özel çalışma alanımın tümör cerrahisi olması nedeniyle birebir hasta – hekim ilişkisini, hem acı hem de tatlı yönleriyle ve daima çok özel ve yeri doldurulamaz bir ilişki olduğunu bilerek yaşamış ve yaşamakta olan bir hekimim. İyi bir eğitim, yeterli teknoloji ve bilgi ile hastaların önemli bölümünün fizik sorunları halledilebilir. Ancak bir grup hasta ve tüm hastaların bir grup sorunları için hekimliğin fark yaratabilmesi gerekir. Bu da hekimliğin sanat bölümünde gizlidir. Bu farkı yaratabilmek için, hekimin yeteneklerini ve sanatsal tatminini, hastanın ise duygularını karşılıklı olarak besleyip geliştirebilecekleri o özel, sanatsal hasta – hekim ilişkisi gereklidir.
Bugün bizlerin de canını acıtmaya başlayan bu değişimi, başta ABD olmak üzere pek çok ” gelişmiş ” ülke bizden önce geçirdi. Sanat tarafını giderek kaybeden hekimliğin ve hasta – hekim arasındaki kişisel ilişkinin yok olmasının getirdiği sonuçları tartışmaya başladılar. Elektronik postalarımıza değişik yerlerden gelen ve hem medikal hem de paramedikal ortamlarda hayli ses getiren Dr. Abraham Verghese’nin konuşmasının ardından, neredeyse bir yıl önce yazdığım ve e-posta ile paylaştığım “USTALARA ÇAĞRI” isimli yazımı hatırladım. Tıpta sanatın ve ustaların önemi ve bu konuda duyduğum kaygılar üzerine yazdığım yazıdan 1 yıl sonra bugün bu konuyu daha derin tartışır olduk.
İbn-i Sina’nın güzel deyişiyle “BİLİM VE SANAT TAKDİR GÖRMEDİKLERİ YERDEN GÖÇ EDER”. BİLİM belki göç etmiyor, ama kazanç endeksli sağlık sanayii ile köşeye sıkıştırılıyor. Kardeşi SANAT ise artık göç yolunda. Unutmayalım ki tıbbın ve hastaların sanata, sanatın ustalara ve ustaların da her sanatkar gibi takdir edilmeye ve sanatlarını geliştirecek ortamlara ihtiyaçları var.
Prof.Dr. Harzem Özger
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