The Hokey, or Evidence-Based Medicine

Evidence-Based Medicine

Once, during surgery at 2am, the Dragon asked me what religion I was.  I had an unexpectedly visceral reaction to the question, not the blood and uterus in my left hand, and said "That's a pretty personal question."  "Is it?" he apologized.  "I didn't think so."  Then I backpedaled and said "That's okay," and jumbled together some approximation of words suggesting, that, what with all the medicine I'd been immersed in for the past 7 years, I hadn't had time to reflect on the world in that way.  You know, and come to conclusions in an empiric fashion.  Maybe using a spreadsheet.  "Well, for some people medicine is their religion, and that's okay," he offered.  "Yeah,"  I said vaguely.

But here's the thing.  And it's a Sting song, so be prepared.  You could say I've lost my faith in science and progress.  Medicine is most definitely not my religion.  I think I believe in what we do about as much as I believe in anything, which is, not to put a definite number on it, approximately 97.5%.  So there's 2.5% of me that says you know what?  Maybe planetary alignment is what it's all about.  Or perhaps meridians.  Need to look more into meridians.  Maybe Western medicine is just a teeny tiny part of the whole of health.  (I actually am pretty sure that statement is true).  And how about that homeopathy?  Vs. rock crystal energy?

Yesterday at work a new colleague expressed her excitement about us newbies arriving.  Maybe now that we're here we can lend a more academic atmosphere than she's experienced previously.  I smiled and nodded.  Because, sure I can digest and regurgitate research with the best of them.  I can look up my statistics and decide whether a paper is accurately reporting the data or fudging a bit.  And, oh, hellfire and brimstone if they're faking it.  I can teach.  I can work with what I "know."  Every day, in fact, I assume that what I've been taught is true, even though I know a fair amount of it isn't.

Because every medical student finds out in the first few weeks of school that "about 50% of what you're learning here will be found to be untrue in the next 5 years."  And how in the hell are we supposed to work with those kind of numbers?  When a patient comes to see me, we enter into what my dad describes as a "sacred trust."  I'm agreeing to be their healer, to use the best of my knowledge to bring them to health.  Do they know that only 50% of the best of my knowledge is actually true?  And which half?  Of what the board believes is necessary to practice family medicine, I know a fair amount.  I score above average on most tests.  Still, I don't get all the questions right.  My dear, trusted patient, let me get out a pie chart and see how you feel.

And don't even get me started on the pure capitalistic fraud that flies routinely under the radar disguised as "research."  Designed to stuff our heads with "knowledge" that was never known to be true in the first place.  That is another issue entirely.

Even if all the research in the world was done by well-intentioned, non-profits and if every single study was randomized, controlled, double-blinded, do you know what?  There'd still be the unknown.  We'll accept something as fact even if there's a 5% chance the results could have happened by chance alone.  Are you okay with that?

Let's take a math break!  What I know = 85%ish boards material x 50% of that is true x 95% probability that results aren't explained by chance alone = 40.3% under ideal circumstances.  Not great.  60% chance I'm missing something here, something maybe astrology could explain.  Or energy vortexes.

And patients don't follow the rules.  Here's what I think.  People are fantastic, infinitely complex.  And that's personality, physiology, psychology, pathology, all of it.  Inherently unknowable in their entirety.  Just like God.

So there you have it.  I'm an agnostic, medical or otherwise.

I used to see this bumper sticker sometimes on the way to work that said "What if the Hokey Pokey IS what it's all about???"  That, my friends, is the true absurdist extreme of what I believe about the world.  What keeps me up at night.  When the kids and the pager aren't.

But that doesn't mean I can't be a doctor.  I believe in a lot of things.  I just believe I might, just maybe, be wrong.  I believe there's a road in front of me.  There might not be, but I'm going to walk anyway.

And here's the other thing.  I love it.  Every day.  I love experiencing what I cannot ever truly know.  And that includes God, and people, and nature.  And actually maybe those are all the same thing?  I guess I'll never know for sure.