Why’d you go and make things so complicated

I love my evidence based medicine (EBM), (maybe i should get a t-shirt with that on it…) i love my journals, and studies and audits.

They simplify medicine for me. I  love reading through characteristics of certain classes of patients and their symtoms and findings and test results. And how if you put enough of this together that you can then figure out what their disease is.

And then once you’ve figured out what their disease is you can provide an intervention and hopefully make them better. The science behind all this is great.

However. There exists a bit of a gulf between the numbers, between the audits and the papers and the list of characteristics, between all these and the patient sitting in front of me.

You see the patient sitting in front of me doesn’t care about any of this. They care because they’re short of short of breath or whatever. They care about getting out of here and going back to vegetating in front of the TV eating twinkies or getting back to the farm to get the cattle in. They care not for evidence based medicine. They hurt my feelings.

Perhaps patients are irreducibly complex in an equation. EBM makes them reducible – and saves lives as a result. However it makes me dehumanise them a bit to get there. Is that too strong? Perhaps so.

Patients are the most wonderful, annoying, fascinating, frustrating bunch of people to work with.

They do not tell you about pure pathology, about the narrowing in their coronary arteries. They tell you about this funny “tightness” that they get. And they won’t tell you that it’s exertional, they’ll tell you that sometimes they get it when they watch TV, sometimes they get it on tuesdays.

Patients are too complicated. They do not have typical symptoms. They will have their chest pain while feeling suicidal. They will have classic symptoms of a pulmonary embolism while at the same time having classic symptoms of pyelonephritis.

They quite clearly haven’t read the script.

Perhaps this is why I love evidence based medicine and logistic regression analysis and Bayes theorem (I’m not sure about the last two, I have only a vague understanding) so much. Because it makes life simpler. Honestly it does.

To do this I must ignore their love for twinkies and the need to get the cattle in. I must ignore all their glorious complex humanity.

As much as I love you dear patient you must become a collection of symtpoms, signs and test results if you want to live through the night.

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2 Responses to “Why’d you go and make things so complicated”


  1. 1 Skeeno September 7, 2009 at 12:04 pm

    LOVE the live Turf Brothers video!

    Its great the way the sound cuts out when the camera zooms in and out. Gives the impression that they’ve had to dip the sound due to the profane lyrical content in Sparkys rap!!!

    Long live turf!

    C.

  2. 2 Nelly And I September 7, 2009 at 5:43 pm

    ta for the compliment skeeno though you did comment on the wrong blog…


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