Medicine and Stuff

Pundits have told us for a a long time that medical knowledge doubles every ten years. For me, that's eight times the knowledge since I left medical school. Medical school was a pain in the wazoo for one simple reason, the amount of Stuff that one had to memorize. There is no doubt that most of the Stuff we learned there we never used again. It is unclear why someone who is destined to work on the brain needs to know the intricacies of the big toe. However, medical education will much more than a bulldozer to move it along into the 21st century.

Have I been able to keep up? Of course not, not even in a narrow little field. And what is the effect of all this new Stuff? It means that most doctors, no matter what their specialty, can't even know everything about that small little corner of the universe. For those of us who are in the more general practices, it is a disaster. For just as things start getting complicated, and we swallow our pride and reach out for help, our ability to access expert advice (consultations) has become a labyrinthian exercise in frustration.

It is also personally frustrating for physicians not to know what is going on with their patients. Many medical problems are either over simple, or over complex. The over simple we can do in our sleep and the over complex drives us up a wall. Rarely do we get those cases that we can sink our teeth into and come out the other end with a good resolution. All too frequently we have dissatisfied patients and terminally disgruntled doctors.

Of course the Stuff that is useful doesn't increase as rapidly as overall knowledge. The human genome, as an example of escalating knowledge, has little practical application. We are far, far away from useful interventions in human genetics in spite of the hoopla from the high tech medical centers. 99.9999999% of us are going to live and die with the genes we were born with.

Most doctors blame the problems we are having in medicine on the structure, the awful mix of market capitalism and greed that pervades the health care industry. There is that. But I don't think we have spent enough time pondering the complexity of our profession. I would wager that it is just not possible for a man or woman to truly be what the public thinks we are. And when we fail, as is inevitable in the human endeavor, we get slammed up against the wall both financially and mentally.

It is no wonder that the number of applicants to medical school dropped overall in the last ten years (although they may have increased a little last year). Most of my colleagues would not recommend that their children become doctors. That's pretty damning.

Maybe I am wrong. Maybe the human brain has vast, untapped resources that will be able to subsume all this Stuff and medicine will enter a new golden age.

Maybe pigs will fly.