Saturday, July 12, 2008

a profoundly ignorant occupation

In his memoir The Youngest Science: Notes of a Medicine-Watcher, Lewis Thomas talks about training to be a medical doctor in 1933:

“It gradually dawned on us that we didn’t know much that was really useful, that we could do nothing to change the course of the great majority of the diseases we were so busy analyzing, that medicine, for all its façade as a learned profession, was in real life a profoundly ignorant occupation.”

Years of increasing success “in diagnosis and prognosis were regarded as the triumph of medical science, and so they were. It had taken long decades of careful, painstaking observation of many patients; the publication of countless papers describing the detailed aspects of one clinical syndrome after another … By the 1930s we thought we knew as much as could ever be known about the dominant clinical problems of the time: syphilis, tuberculosis, lobar pneumonia, typhoid, rheumatic fever …” Except, that is, how to “change the course of the great majority”; cure was up to patient’s immune system.

“The treatment of disease was the most minor part of the curiculum, almost left out altogether.” Sure, they were taught about “the mode of action of a handful of everyday drugs: aspirin, morphine, various cathartics, bromides, barbituates, digitalis, a few others.” But these primarily treated symptoms. They weren’t curatives.

Mostly what doctors did, Thomas says, at least when we’re talking patient care, was listen, hold your hand and act as though they were responsible for you. They were living breathing walking authoritative placebos – not much different from shamans.

Patients these days miss that kind of doctor, the handholder, the man with the bedside manner. But, says Thomas, though he understands and sympathizes, he wouldn’t trade the many actual cures we now have for a kindly smile.

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