Thursday, 8 December 2011

Construction and Reconstruction.

Just yesterday I received an email notice stating that some pins used in total knee replacement are being recalled by the company. Lucky for me, I have never used these pins during surgery. However, this and notices like this are a wake-up call to me and others regarding our routine use of man made materials in a human person.

So many people suffer from conditions for which we have no good solutions. What we don't know in medicine so dwarfs what we do know. But people do not want to hear this. What they want is for me to tell them "We can fix that. We can make you 100% again."

Fact is, there is no such thing as making someone "100%. " And what is One Hundred Percent anyway?

An old medical joke comes to mind:

Patient: "Doc, after surgery, will I be able to play the violin?"

Doctor: "I don't see any reason why not."

Patient: "GREAT! Cause I've never been able to play before!"

While we as physicians have come a long way in treating painful and dangerous conditions, we are simply human. We aren't magicians. But the perception of physician as magician, or shaman, persists. There must be some magic formula, some "laser surgery" that can cure our patients. More than one patient of mine has come to the office demanding an MRI. These folks believed that an MRI (which is a diagnostic test, used to find out what might be wrong with someone in certain conditions) would cure them. Cured by a test!

Perhaps we can apply the Heisenberg uncertainty principle to disease. Perhaps the hunting for them or the studying of them can knock the disease processes out of their orbits. Just enough to cause a spontaneous cure.

If only.

Truth is, we can do what we know how to do. We can continue to research problems and find new and better solutions. We can think and try and hope. We can believe that one day we'll be smart enough to tackle the toughest problems and to bring our patients back to that One Hundred Percent level.

You see, doctors want to help. We become frustrated when we can't. And sometimes, in trying to help we make things worse. By inserting faulty pins. By performing surgeries that don't come out as we had planned. By doing what we know how to do since we aren't smart enough yet to know how to fix the problem.

Sometimes the hardest thing to do as a physician is to admit when we don't know. Perhaps a course in humility ought to be added to our medical school curricula.

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