Tuesday, January 14, 2014

We Do Not Know Everything

Sorry if that's news to anyone, but sometimes, the truth hurts.
Or more specifically, you hurt, and us not being able to figure out why just pisses you off.

We do science here. If you want omniscience, the chapel is behind the gift shop.

It's why docs - hell, everyone - loves being able to point to that whatsis on an x-ray, CT scan, MRI, or ultrasound and say, mentally or out loud "A-HA! Got you, you little s.o.b.! That is the problem!!" and then merrily set about treating it with all dispatch.

It's why working in fast-track breaks your back while turning your brain to jello: 99% of the time we know what the problem is, because there's either blood oozing out or a bone poking someplace where it shouldn't be. Thus the work there generally devolves to how fast we can do an Indycar pit stop on your problem, rather than trying to figure out why something isn't right.

But even at that, and with all we know, we're still at Rumsfeld's Conundrum on what we don't:
there are known unknowns - the things we know we don't know;
and there are unknown unknowns - the things we don't even know we don't know.

And while what we know grows geometrically, the number of unknowns grow exponentially.
One bare example is ulcers. They finally gave a Nobel Prize a few years back to the doc from Oz who was telling them for twenty years that bacteria play a large part, and to try treating it with antibiotics. Unfortunately, he was telling surgeons, for whom the primary ulcer treatment was surgical at that time. The happy ending is that eventually science won out over self-interest, but it took decades of ridicule and needless patient suffering. In any event, I can now rip out the chapter on ulcers from the late 1970s, and throw it away.

Medicine, as a whole, is not populated by heartless morons, rather the reverse. In point of actual fact, an EMT or paramedic today has more medical knowledge and expertise than what most doctors had through the end of the Civil War, or even to the turn of the century in 1900. This is the reason army medics and navy corpsmen save so many lives today, compared to the casualty rates at Gettysburg. Rapid transport, aseptic technique, and antibiotics do most of the heavy lifting, but unlike Col. Anyone, M.D. in 1863, today's medics know all that.
We still don't let them take off limbs or do appendectomies in the field (with certain specific exceptions, and only in the military, or catastrophic situations like under collapsed freeways during an 8.0 earthquake).

And what we do know, in about 98% of cases, you can take to the bank. I may not know why you're making your 9th kidney stone in 12 months, but I can darn sure show you where it is, whether it will pass easily or not, and make the pain significantly better in a few minutes until it does.

But sometimes, some things we simply can't suss out. Sometimes the technology/pharmacology isn't good enough. Sometimes, the technology hasn't even been invented. And sometimes people lie to us.

But the problem is astronomically rare that we'll tell you we can fix anything. It's usually a case of you thinking that, beyond all rational expectation, and usually a good bit of reversion to the magical thinking of childhood.

We know you're the hero of your own internal monologue, but before you make us the villains, listen to what we do know, and give it a shot, before you start rewriting history to all the subsequent audiences for whom you recount your tales. Especially if it's us again, and we remember you from the last ten visits.

So take the pain med for the pain, and the tetanus shot for the prophylaxis of not dying a horrible death paralyzed in rictus bent back like an English longbow while you slowly dehydrate and suffocate when your breathing muscles are overcome by terminal tetany, staring back at the wall through unclosing eyes. Or ignore what we do know, go home in pain, and die like that, thinking silent unuttered curses on the imaginary medical training and dubious wisdom of your current hero, "Dr." Jenny McCarthy.

1 comment:

  1. I'm feeling sort of stupid lately, so I'm going to let Senor Santayana say it for me (w.r.t. the anti-vax crowd) - "Those who cannot remember the past are condemned to repeat it." Except I suspect the future could actually be worse than the past.

    Will we see the resurgence of all manner of horrid diseases in our time? When (probably not "if") these monsters return, and develop medication-resistant strains of themselves, what will it be like?

    I shudder to think about it.

    Good piece, Shep.