Medicine as an Art
Medicine, in its ideal form, is far more art than science.
There was a time when I worked for a company which provided ethical oversight to clinical trials and other forms of human experimentation. Most of the doctors we worked with were ‘old hats’ at it, and understood the importance of following protocols as well as meticulously discussing the IC (Informed Consent) document with potential volunteers. Once in a while, however, we would deal with new doctors - “Naive Principal Investigators” we called them - and would have to train them in how to proceed with the trials.
Now, any decently designed trial will have an ‘escape’ path, policies and procedures to follow when the volunteer isn’t responding well, which insure the patient is not endangered, and the data is captured for the study. This is good science, and, if the patient understands it going in to the study it’s fine ethically, but good medicine is more than that. Good medicine would involve tinkering with everything - dosage, possible interactions, etc., to make sure that each individual patient is given the best possible care. The ‘tinkering’ might be out of protocol, and has no place in large scale experiments where every result has to be reproducible.
People don’t go to doctors to find out, beyond a shadow of a doubt, what the problem is, they go to the doctor to get better (or to keep from getting sick in the first place). Let’s face it, the two are closely related, but that’s not the same as identical.
Having said that good science is not good medicine, I’m still at a loss to understand a situation which recently came to my attention. A fairly young (in her fifties) woman sufferred a mild stroke, losing some function on one side of her body, which made walking difficult. Her neurologist told her it was *not* necessary to go to physical therapy, since she had ‘done her own’ therapy and could, once again, walk.
Her condition was more or less stable for nearly a decade, but then she began to fall spontaneously, and with increasing frequency. She went back to the same neurologist, who confirmed that she had not had a second stroke, but that the neurological deterioriation had continued. He asserted that physical therapy still would not help, since it would not halt the decay. Fortunately the woman listened to friends and family rather than the doctor, and got herself a physical therapist. Within two weeks her symptoms had improved. She felt as though her muscle mass had
begun to build back up, and she caught herself twice when falling (something she had not been able to do a month before).
Obviously, the neurologist was practicing terrible medicine, based on a poor understanding of the science. True, the neurons damaged in the stroke cannot possibly recover. Equally true, new neural pathways can be formed by repeated use, which he (presumably) thought was what happened when she ‘did her own therapy’. What I don’t understand is why she was NOT sent to a physical therapist as a matter of course, despite the fact that she showed improvement on her own. Did the doctor assume it was a waste of time and money? Was it an insurance issue?
Very strange indeed.
