Mea sententia

Over the last 44 years I have witnessed an unfortunate transformation in my chosen field of medicine.

Poor communication is the commonest cause of poor outcomes in medicine. Taking things for granted instead of asking questions is one form of poor communication.

My parents never yelled, let alone spanked. We always understood what was expected of us and feared failure rather than punishment. They expressed disappointment far more often than they showed anger. They often asked us to devise our own punishments. And, perhaps above all, they were masters of the object lesson.

Some of the things we learn during our medical training are startlingly obvious, but only after we have learned them.

I recently received an email from my employer, with a link and a request to fill out a short survey evaluating a new service available to our patients. I had a brief gap between patients, so I clicked and did the six questions. As I hit submit, it occurred to me that the survey seemed familiar. Hmmm. Looking back in my older emails, I found that I had received a similar request from the same group about 2 weeks earlier, with the same link. I contacted the person who had sent the second email.

The scientific method has given us modern medicine, with astounding abilities to diagnose, treat and even cure. Until the last century, medical treatment was futile at best and fatal at worst. Cure was not possible and the touchstone of our profession was comforting the patient. 

Darwin observed: “It is not the strongest of the species that survives, nor the most intelligent that survives. It is the one that is most adaptable to change.” This profound observation is poorly understood and usually ignored by institutions and organizations.

Evidence based medicine has much to offer, but one has to remember Einstein’s famous remark: “Not everything that counts can be counted, and not everything that can be counted, counts.”

It was about 2:30 am when the phone rang, waking me from the deepest and best part of sleep. It was the answering service, and they patched my patient through.  

Me: (Still groggy, trying to wake up.) “Dr Elias here, on call for Family Health. What’s the problem and how can I help?”

Female voice: “I can’t sleep.”

pause…

Osler, often referred to as the Father of Modern Medicine famously said: "If you listen carefully to the patient, they will tell you the diagnosis.” He emphasized both the value of a careful history in medical diagnosis and the value of learning from one’s patients. Ask any practicing clinician and they will have anecdotes that illustrate how right he was. One stands out for me.