In a book of poems entitled, "Imperfection: Swear By the Night and Other Poems" (1936), the late Nathalia Crane wrote this: "Let go the lure, the striving to unmake; Behold the truth whenever heart may ache. There is a glory
In a great mistake.
In a great mistake.
Atul Gawande, a surgeon, is the author of "Complications: A Surgeon's Notes On An Imperfect Science." If I were a physician, I would be grateful to the good doctor for writing this book. I really would, despite the fact that Dr. Gawande's central message is don't trust doctors!
No, Dr. Gawande did not suggest doctors are medical Madoffs or otherwise a cabal of bad actors. What he did was show that doctors are like the rest of us - fallible. They make mistakes. Unlike a mistake a clerk at a dry cleaners might make in giving you the wrong shirts, or something like that, doctor and other medical errors could cost you an arm or a leg, or worse.
We have all been patients; most of us will be patients again. While we expect doctors and other care-givers to get it right, to offer the correct diagnosis and treatment, one or both are quite unlikely, at least the first time out. Perfection is theoretically possible; doctors do get most of it right, for the most part, quite often, but that leaves lots of occasions when errors are made. You are very foolish if you assume a doctor's work is spot on, especially if your case is somewhat complicated (e.g., heart problems). That is one reason you may have heard the term second opinion. Or the word malpractice. Other terms prompted by the fallibility of doctors, like all humans, include iatrogenic medicine, complications and death. You get the idea, I'm sure.
Gawande explains why it is that no matter how caring doctors try to be, how efficient the institutions in which they work are, and how effective a few protocols for treating varied illness have been in other cases, you must not be complacent or assume the best. Be an active patient. Pay attention and become well informed. Be vigilant and know the options, including this one - do nothing. Not every problem has a cure, and not all illness causes are discoverable nor are all symptoms treatable.
Gawande makes clear that medical customers have unreasonably high expectations, whether the doctor advice is for obesity pills, vitamins, tests or dramatic procedures - like surgery. Surgery? Such is mysterious, uncertain and fraught with the likelihood that errors, mistakes and screw-ups will occur.
One reason doctors do not fully explain things (e.g., you're dying, ruining your health with lamebrain habit patterns and so on) is because they are overly polite. Or, they don't want to upset you. Or, they don't really understand the situation and don't realize it. This is a short list of possibilities - there are many more reasons why you might not obtain all the information you need from a physician to make the best decision about your problem and what, if anything, to do about it. Here are a few examples of surgical variables. It would be good to know of such things, if there were a way to gain such insights (there is not):
* The young surgeon making the incision on your abdomen has never used a scalpel on a human before.
* The chief cardiologist is senile but nobody will blow the whistle because he is such a good fellow, popular and a community leader held in high esteem for charity and other community roles.
* The head nurse has a drug problem.
* The hospital has a higher than normal record of incidences of infections and mortality for your procedure.
As Gawande put it, We would all be better off being told things straight, even if it means accepting ugly facts.
Gawande also adds this: To much of the public, and certainly to the lawyers and media, medical error is fundamentally a problem of bad doctors... Mistakes do happen. We tend to think of them as aberrant. They are, however, anything but.
In a very real sense, mistakes are part of learning the doctor trade. This is little comfort for you, since nobody wants to donate a limb or a relative to medical education. As you might recall when learning your trade, the educational process involves not just making mistakes but benefiting from the lessons gained in doing so. No matter how expensive the medical school, or fabulous the quality of instruction, or how great the quality controls in the hospitals, practice does NOT make perfect. However, practice does make better, so other things being the same, an experienced doctor is a good thing to have going for you. Other things being the same!
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