Excellent article.
Star Trek proposed a magical technical Tricorder as an ultra compact futuristic little black bag. You could whip it out and aim it at someone and have scads of useful data instantly.
Reality delivered us new tech like MRIs that require their own room at a hospital. Instead of the doctor going to your home and seeing you in the context in which you live, thereby providing substantial information without having to ask, the patient now goes to the clinic.
The result: The patient has ceased to be a whole person and product of their environment in the eyes of the physician. They are merely a specimen in a petri dish.
At one time, most humans lived in small communities where everyone knew each other and the doctor was one of the smartest and most educated people there. He was in the wisdom business.
Now doctors are expected to still deliver the results of being in the wisdom business while largely being reduced to technicians who lack the wealth of contextual information that once informed their practice of medicine.
This is compounded by larger communities and mobile cultures where we no longer know everyone for years and years.
How we fix this, I don't know.
But I am reminded that House was tentatively called "Everyone Lies" in preproduction. Figuring out the lies being told in every episode was a critical part of solving the medical mystery featured.
Modern physicians no longer know x patient is an alcoholic and hiding it and y patient is a philanderer whose sickly wife stopped sleeping with him years ago and it's both rude and ineffectual to ask about such things. You will likely be lied to.
But details like that are critical to sorting out what's really wrong medically and thus how to treat it effectively. And such issues absolutely fall in the purview of medical humanities, an aspect of the profession that desperately needs rethinking to resolve what ails modern medicine and thus improve health for modern people everywhere.
Excellent article. Practicing anesthesiologist of 25 years. Agree 100 percent with the problems highlighted in the article. These problems are increasing day by day with increasing algorithmization and protocolization of everything. So as the article mentions , there are two many individual variations and edge cases in day to day practice of medicine. An experienced doctor will have a a pretty good idea if following a protocol blindly can harm a patient but if they act on their experience and deviate from protocol they are open to liability even if the outcome was good. But I don't believe humanities education us the answer to this problem. It needs a system wide reset.
The scenario described here reminded me of https://www.astralcodexten.com/p/heuristics-that-almost-alwa.... Maybe the point is that expertise is a two way street: when you have real expert classes, you must actually trust their judgement.
The difficult edge case presented in the opening is that the standard protocol prohibits a decision that sensibly should be made. I feel the obvious fix is to amend the protocol. The time at which an operation occurs should factor into the protocol, we do prefer complex operations to occur when experts are most available. Rather than abandoning the protocol, it should be updated to reflect this. Of course there will still be cases with the protocol doesn’t handle well, but eventually those will be amended as well.
> Several years ago, I was involved in a case that illuminates the difficult position many doctors today find themselves in. The patient was pregnant, close to delivery, and experiencing dangerous declines in her baby’s heart rate. She had been on a blood thinner, which kept me, the anesthesiologist, from placing an epidural in her back. She also had strange airway anatomy, which would make it a struggle to put her to sleep quickly if an emergency cesarean section became necessary. I advised the obstetrician to perform an elective cesarean section now, in advance, while we had good working conditions, and not to wait for an emergency, where time is of the essence, and where the delay needed to induce general anesthesia might seriously injure the baby.
I am a doctor and that scenario scares me. This has a very high likelihood of stuff hitting the fan and you need to think about your plan when it does.
You want stuff to hit the fan during daytime when everyone is around. In this case, during the day surgery is around, ENT, around, other anesthesiologists all of these can rush in if needed to help you secure an airway. You also have the neonatologists around.
If it happens in the middle of the night, the staffing will be much reduced and you won’t have as many resources available.
One of the most important things to learn as a doctor is when algorithms and guidelines actually apply to the current situations.
“Life is short, the art long, opportunity fleeting, experiment treacherous, judgment difficult”
- Hippocrates