My subject is the art of surgery, its history and progression into the present high-tech age. I have included artists' images from the collection of jama covers that I hope will combine with my words to bring some inspiration. A new century in American surgery is under way. It is fast moving, even frantic, with new science and technology appearing every day. In this stressful milieu, let us pause to view Michelangelo's Creation of Adam from the ceiling of the Sistine Chapel (Figure 1). I propose that we might also pause to reflect on the art of surgery. Practicing surgery in our current world—engaging in humane dialogue and making clinical judgments amid challenging medical, ethical, and economic forces at the interface of patient and surgeon—is a complex undertaking. It is a challenge that our forebears in surgery could not have foreseen. Furthermore, they could not have predicted the wave of disenchantment expressed by physicians and patients at the very time when the surgical armamentarium has become larger and finer and the achievements more spectacular than ever. In the literature of our field, the following question is posed: "Must there be an inverse relationship between technical outcome and service experience?"1 No. However, Leon Eisenberg states, "[P]ublic dissatisfaction with care received has been increasing in recent years despite the greater and greater proficiency of medical and surgical specialists in reducing morbidity and mortality."1
Michelangelo Buonarroti (1475-1564), Creation of Adam, 1511-1512, Italian. Fresco, Sistine Chapel, Rome. JAMA cover, October 10, 1990. Courtesy of Frank Meshberger, MD, Anderson, Ind.
H. David Crombie, MD
David Teniers the Younger (1610-1690), The Surgeon, c1670, Flemish. Oil on canvas. 59.7 × 73.7 cm. JAMA cover, July 15, 1988. Courtesy of the Chrysler Museum, Norfolk, Va; gift of Walter P. Chrysler, Jr.
John Singer Sargent (1856-1925), The Four Doctors, 1906, American. Oil on canvas. 327.7 × 276.9 cm. JAMA cover, June 2, 1989. Courtesy of the Alan Mason Chesney Medical Archives of the Johns Hopkins Medical Institutions, Baltimore, Md; photographed by Aaron Levin.
Walter Gilman Page (1862-1934), The Grandmother, 1889, American. Oil on canvas. 92.4 × 73.3 cm. JAMA cover, August 12, 1988. Courtesy of the Los Angeles County Museum of Art, Los Angeles, Calif; gift of Mrs Barney Kully.
Edouard Manet (1832-1883), The Reader, 1861, French. Oil on canvas. 97.79 × 80.01 cm. JAMA cover, July 23/30, 1997. Courtesy of the St Louis Art Museum, St Louis, Mo.
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