Medical care is about our life and death, and we’ve always needed doctors to help us understand what is happening and why, and what is possible and what is not. In the increasingly tangled web of experts and expert systems, a doctor has an even greater obligation to serve as a knowledgeable guide and.
You have a cough that won’t go away – and then? It’s not science you call upon but a doctor. A doctor with good days and bad days. A doctor with a weird laugh and a bad haircut. A doctor with three other patients to see and, inevitably, gaps in what he knows and skills he’s still trying to learn.
In some way, it may be in the nature of surgery itself to want to come to grips with the uncertainties and dilemmas of practical medicine. Surgery has become as high tech as medicine gets, but the best surgeons retain a deep recognition of the limitations of both science and human skill. Yet still they must act decisively.
Medicine requires the fortitude to take what comes: your schedule may be packed, the hour late, your child waiting for you to pick him up after swimming practice; but if a problem arises you have to do what is necessary.
Human judgment, even expert human judgment, falls well short of certainty.
They believe in practice, not talent.
Skill, surgeons believe, can be taught; tenacity cannot.
With repetition, a lot of mental functioning becomes automatic and effortless, as when you drive a car to work. Novel situations, however, usually require conscious thought and “workaround” solutions, which are slower to develop, more difficult to execute, and more prone to error.
Yet although the odds were against me, it wasn’t as if I had no chance of succeeding.
Surgery itself is a kind of autopsy. “Autopsy” literally means “to see for oneself,” and, despite our knowledge and technology, when we look we’re often unprepared for what we find.
A resident has a distinctive vantage on medicine. You are an insider, seeing everything and a part of everything; yet at the same time you see it anew.
But the truth of the matter is that it tends to raise as many questions as it answers.
Doctors with high confidence in a judgment they made proved no more accurate than doctors with low confidence.
Errors are too common and widespread to be explained so simply.
We tend to give some variables too much weight and wrongly ignore others.
Even good doctors can go bad, and when they do, colleagues tend to be almost entirely unequipped to do anything about them.
They belong to the connected and the knowledgeable, to insiders over outsiders, to the doctor’s child but not the truck driver’s. If choice cannot go to everyone, maybe it is better when it is not allowed at all.
Yet compassion and technology aren’t necessarily incompatible; they can be mutually reinforcing.
The goal is to use explicit, logical, statistical thinking instead of just your gut.
The way that things go wrong in medicine is normally unseen and, consequently, often misunderstood.