'The Future of Doctoring'
CAERS SUBSTACK ARTICLE #20
‘THE FUTURE OF DOCTORING’
CAERS SUBSTACK ARTICLE #20
Yogi Berra was a famous baseball player, and much of his renown related to numerous outlandish sayings attributed to him, rightly or not. One of my favourites is: ‘It’s tough making predictions, especially about the future’.
If I asked you what I spent my days doing when I was in practice, my response might shock you: my job was to predict the future for my patients, somewhat similar to the clairvoyants at the local fair.
Okay, I know I am exaggerating a little because I did depend on medical science not mysticism to make my predictions. But the reality is that the best I could offer any given patient was a well-educated guess about what the future had in store for them. Surprised?
No matter the reason for a visit with me, every patient ultimately wanted to know what awaited them down the road. Was the laceration serious enough that they may never be able to play guitar again? Did a certain symptom reflect a worrisome disease that could adversely affect the quality and/or quantity of their future life? What could modern medicine do to help, and how successful would it be going forward?
Even if we are in severe discomfort, we really want to know if it will end and when, because each present moment of experience vanishes quickly into the next moment of experience. If a person was overcome by an excruciating pain and knew that it was not a reflection of any underlying problem, and that after a few seconds it would disappear never to return again (a freaky one-off), they wouldn’t bother to see a doctor. By the time they could, or by the time the doctor could intervene, that brief moment of pain would have disappeared into the past and be nothing more than an unpleasant memory.
So, it really is the future that preoccupies us whenever we consult a doctor, or for that matter our investment advisor, our favourite weather authority, or our car mechanic. They, too, are fortune tellers. All of them can only offer probabilities for the future based on previous data, and the patterns that have been gleaned from that data.
I discussed in a previous article (Article #15, ‘When Treatment Doesn’t Work as Intended’) that biological systems are not just complicated but complex in a way that physical systems are not. Your cell phone interacts with the tower that sends it data, but neither are particularly changed by that. However, the various cells in your body interact with one other in ways that change each of them in a dynamic fashion. Platelets in your blood stream and the blood vessels in which they travel (like veins and arteries) can interact and change one another by producing a clot that prevents you from bleeding to death. And because each of the more than seven billion people on the planet is unique, there are lots of variations as to how that unfolds exactly. It is easy to assume that we understand how each individual human body works as well as we understand how cell phones work. However, when we forget the more complex and dynamic interplay inherent in biological systems it is easy to oversimplify and convince ourselves that we comprehend more than we really do.
And that means that predicting the future for medical patients is even more difficult than doing so for non-living systems like cell phones. Any honest medical ‘expert’ will tell you that their present expertise is a rather fleeting phenomenon. One of the biggest challenges I faced when in practice was keeping up with the latest ‘expert’ opinion, because so much of that knowledge changed over time, and sometimes radically so. Lots of things I did early in my career I stopped doing over the years as our understanding improved. ‘Facts’, and the predictions we made based on those ‘facts’, were less accurate decades ago than they are today, and no doubt the same will be true decades from now.
Unlike the store that can sell you a specific cell phone on their shelves and its accompanying data plan, in medicine we can only offer predictions of what our products and services can offer you in the future. And because none of us is an exact replica or clone of another person, even identical twins, our predictions cannot be the same, or equally accurate, for each and every human being.
It is important for patients to understand that an interaction with any health care professional is a probabilistic adventure into the future. During the pandemic, did the authorities explain that they were making predictions about the future and the tremendous challenges in doing so? Have they been willing to admit when their predictions were wrong? In medicine, we utilize the process of consent to deal with this reality of uncertainty, and that will be the topic of my next article.
J. Barry Engelhardt MD (retired) MHSc (bioethics)
CAERS Health Intake Facilitator
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