It’s all too easy to try and quantify everything in medicine.  We are, after all, under the widely held delusion that medicine is like physics.  A thing that follows fixed, predictable mathematical models.  A thing reproducible if only algorithm A is followed for this disease and algorithm B is followed for that disease.

This belief is also held by the government, which doesn’t want to pay for re-admissions or mistakes.  Because it is believed that all things in medicine can be known from an exam, some labs, some tests and some studies.

Nevertheless, things happen.  Disease are transmitted in public or by families.  Medications don’t always work.  Bodies change.  Bodies age.  Humans are non-compliant.  Humans are suffering from physiologic phenomena we can’t yet comprehend.  Viruses are synergistic with other diseases.  The immunity of our patients is affected by their happiness, their diet, their work history, their family.  The algorithms necessary to make medicine anything like physics would be mathematically beyond comprehension.

And of course, physics isn’t that predictable after all.  Especially at the quantum level, when we begin to examine the transitions between matter and energy, time and space.  What looks simple; an apple falling next to Sir Isaac Newton, suddenly becomes electrons moving in unpredictable paths, or a Big Bang in which everything was once the size of an atom.

Physicians, too, are easily influenced.  I was thinking this morning that my eyes don’t want to open.  I worked last night until 2 am.  This morning, the phone would not stop ringing, my daughter wanted to tell me she couldn’t find her music book, and for whatever reason, I lay on the pillow in vain, hoping for sleep after waking around 7:30.

Will that affect me today, as I return to work?  I hope not.  I’ll be washed, fed and caffeinated.  I’ll see my wife and children whilst fully awake.  It is my belief that God will give me the alertness I need.  I have, besides, spent almost 20 years learning to work through fatigue.

But it stuck with me.  The practice of medicine, for an individual doctor, can be affected by joy or sorrow, fear or hope, a good breakfast, a bad lunch, a sick child, a bad investment, a poor night’s sleep, a barking dog, a sad spouse, a dying parent, a lonely week.  It can involve our blood pressure, our weight, our fitness or our depression.

It isn’t just that we are good, bad, smart, dumb, caring or uncaring.  It’s that we, like our patients are so remarkably, wonderfully, and painfully…human.

Life is not so simple, is it?

Edwin

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