nends:

 The Osteology Lesson of Dr. Sebastiaen Egbertsz by Nicolaes Elias Pickenoy

Seeing paintings like this reminds me that the practice of modern medicine is a relatively new profession. Prior to widespread use of antibiotics, vaccines, and “sterile” technique, doctors couldn’t offer much but potions and advice based on professional hearsay. Only about 10% of “doctors” graduated from a medical school 100 years ago. The “studies” those students learned from were not much more than case studies. “Evidence” really didn’t exist much back then. And today, although we have studies on populations that suggest one therapy works 5% better than another therapy, we still have no significant way to generalize those population studies to you as an individual and sway your outcome beyond experience and a gut feeling, the so-called “art of medicine.” If the art of medicine is based on:

  • experience
  • gut feeling
  • diagnostic data
  • and a doctor’s knowledge of the patient and his or her everyday life

How has the art of medicine truly advanced? In the past, doctors tended to spend more time with you, treat your whole family, and live in your neighborhood. Now they don’t. They don’t know you anymore. And I think we can conclude from this that the “art of medicine” now only has:

  • experience
  • gut feeling
  • diagnostic data
  • knowledge of the patient

“Knowing your patient” has been replaced by “profiting from your patient.” Combine this with society’s belief that doctors must do something for you, rather than just leave you alone…and you’ve got problems. Most importantly, you’ve got safety problems:

In the 10 years since publication of the Institute of Medicine’s report To Err Is Human, extensive efforts have been undertaken to improve patient safety. The success of these efforts remains unclear…In a study of 10 North Carolina hospitals, we found that harms remain common, with little evidence of widespread improvement.

Maybe that’s why the latest estimates suggest that one in seven hospitalized Medicare patients experienced an adverse event such as excessive bleeding, a hospital-acquired infection or aspiration pneumonia. Those events, both preventable and not preventable, led to about 180,000 deaths a year.

However, we are getting better and better at diagnosing you– new tests are appearing every year. But this only gives us more evidence to actually do something about the problem. Therefore, doctors can do more and more for our bodies every year. But the second a doctor does something for you, is the second you are exposed to the risks of that something. So the real question you must ask yourself and your doctor is:

What are the risks of doing something vs. not doing something? 

Of course the majority of docs will answer you saying they should do something because that’s what doctors do…we do something. And society expects us to do something. We’d be bad doctors if you spent half your day visiting us and you walked out with 6 minutes of a good talking to and nothing to pick up from the pharmacy.

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