On Training the Medical Mind

https://scholars-stage.blogspot.com/2021/04/for-god-and-progress-notes-on-liberal.html

by ascertain • 5 years ago

70 14 5 years ago

scholars-stage.blogspot.com

sebmellen4• 5 years ago

I cannot help but think Osler is right: the physician is called to “exercise an influence of the strong upon the weak, of the righteous upon the wicked, and the wise upon the foolish,” and must prepare his or her soul to do so.

Could it be that medicine was more individually "caring" before the introduction of highly-codified procedural standards and allopathic/evidence-based medicine?

A personal anecdote: I've had a tremendously hard time finding an ophthalmologist to treat a chronic and very annoying type of allergic conjunctivitis. I finally just found a great doctor — an "Osler type." She actually took the time to try to diagnose the issue, walk through my medical history with me, and focus on figuring out the root cause. All the other ophthalmologists I've been to have just put me on steroidal eye drops after running through a checklist.

I've seen this same thing in other parts of my life too. I had a period of about two years when I was a (younger) teenager where 3 psychiatrists and one GP diagnosed me with depression, anxiety, ADHD, narcissistic personality disorder, Bipolar I disorder, Bipolar II disorder, and more.

I finally got off the treadmill of medications and completely unfounded diagnoses, took a few psychedelic trips, and left home to travel alone for a month. On a follow-up visit my psychiatrist was stunned to learn I was leading a successful life without medication. (He had previously told me that "people with your kind of depression almost always need SSRIs for life.")

If only more doctors had the empathy and courage to wean themselves from the checklist style of medicine and practice medicine in the way Osler emphasizes here — by preparing their souls to do so.

rscho2• 5 years ago

We can't "wean ourselves from the checklist style" because it's enforced by many systemic factors, not the least of which being legal repercussions. Modern medicine is "defensive first ask questions later", and the "checklist style" is the best way to have a good defense. This is orthogonal to whether you actually are a good doc.

corty• 5 years ago

I think the "good doctor" starts as soon as the checklist is finished and there is no result yet. I'm not a medical professional, but in other areas, using a checklist is helpful and necessary. You may cut short the known-useless parts if you really know what you are doing. But often, "known-useless" is a fallacy and you waste time on your firm-but-wrong intuition. Which is OK if you just waste your time, but not OK if it is about a patients (life-)time.

I think there are "House, M.D."-style situations where the checklist will kill your patient and a quick hunch will save it. But the usual doctor's visit because of an itchy eye isn't.

As an IT professional, just think of the number of times where it really was one of point 1, 2 or 3 on the checklist: "is it switched on?" "is it plugged in?" "have you tried turning it off and on again?". Of course those are often useless. But when they are not they do waste far more time than just quickly checking...

selimthegrim• 5 years ago

I don’t understand how the guy can write so well and yet confuse tinderhooks with tenterhooks in the comments.

On Training the Medical Mind

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