- Joined
- Aug 25, 2010
- Messages
- 11
- Reaction score
- 0
We had a professor/physician tell us this during an ethics lecture on our newly undertaken "social obligation."
We had a professor/physician tell us this during an ethics lecture on our newly undertaken "social obligation."
A lot of it isn't. A lot of it is just hypothesis, guesses based on what makes sense in the framework of scientific concepts with no experimental verification. Add in the difficulties of applying micro-scale or population-scale scientific principles to the individual and things become even cloudier.
Right now, the field is closer to cooking than science. You take some scientific principles, apply them the best you can and ultimately rely on a lot of trial and error to point you in the right direction.
The field is transitioning, but it's asinine to pretend clinicians are practicing 100% science when just about every disease process has "through mechanisms not full elucidated" somewhere in the description. A lot of what is done clinically has yet to be verified via studies and even the studies that have been done are still trickling their way down into practice...
A lot of it isn't. A lot of it is just hypothesis, guesses based on what makes sense
Every win, loss, mistake, outcome, trial, error and decision in medicine can fit into this neat little chart.
He's correct. Medicine is a business.
*runs for cover*
I heard these things few times between different rotations, especially in medicine rotation. And I (respectfully) don't agree and understand the notion of the saying that medicine is not science." It is not "exact science," sure. But if one practices correctly (i.e. evidence-based medicine), it is still scientific.
To elaborate, we may not cure or "get it right" 100% of time, but it does not mean it is not science. It simply means we just don't know. But we still use (or at least should use) empirical treatment results, META analysis, statistic correlations, etc, to give best proven method possible for diagnostic workup and treatment modalities. That is all that can be done. Study the observations we can obtain, form an educated, reasonable hypothesis that is grounded on relatively well-grounded principles, try the hypothesis, then rinse and repeat. This is what science is.
I think what people more likely are saying is that science does not always gives us all the truth we want. But then, I knew I wasn't going to play god just because I would wear white coat even before going to med school. Sorry if I sound cynical, but from personal experience, the people who said (in my clerkships) that medicine is not an exact science also tended to be people who put overemphasis (and wasted lots of time and effort) on much less "scientific" issues like social and ethical issues of medicine.
Aaaaaaaaalmost got it... you just forgot the next few steps!
Here, I got you this cute diagram from an elementary school resource site!
Just because you are sometimes *wrong* doesn't make the process less scientific, it just means that your hypothesis was based on incomplete information. Personal experience adds information (as does the experience of others, i.e. Pubmed)
Every win, loss, mistake, outcome, trial, error and decision in medicine can fit into this neat little chart.
I agree with you. The point is simply that EBM is a relatively new iteration of medicine. We're still at a point where a lot of medicine has not been evaluated under the lens of the scientific process and is simply practiced out of seeming reasonable, having a historical tradition, and providing anecdotal evidence of success. Medicine is moving steadily toward being a science, but the field is not fully there yet.
You have to test the hypothesis for it to be scientific method. Which was the point. A lot of medical practice is based simply on a mix of tradition and what sounds reasonable.
I'm sorry, I can't find a cute chart to break it down for you. Just re-read it a few times very slowly...
You have to test the hypothesis for it to be scientific method. Which was the point. A lot of medical practice is based simply on a mix of tradition and what sounds reasonable.
I'm sorry, I can't find a cute chart to break it down for you. Just re-read it a few times very slowly...
But let's not ignore the huge parts of medicine that are NOT evidence-based.
Ex 1: doc prescribes antibiotics for a kid with otitis media with effusion (NOT purulent, i.e. not an acute bacterial otitis media), even though the studies suggest he's not supposed to do it.
Why? I'm sure he's got his reasons... maybe the parents wouldn't be that happen with the doc if he didn't give'em out, perhaps... but point is, he's not "going by the science".
Ex 2: recent study shows that you're supposed to test shoulder ABductor mm strength a certain way... but our sports med prof specifically told us NOT to do it that way 'cuz the old docs don't do it that way, and we'll look like tools if we do it the new (and better) way.
1) Doing something irrational with potentially harmful side-effects (bacterial resistance, or the risk inherent with any/every medical procedure) in spite of one's best knowledge is wrong. Period.
2) Not doing something to the best of one's ability, based on tradition, is unbecoming a human being. The old docs may have "evidence" that the new way is invalid. It is up to your mind to decide if their reasoning is sound.
You have just listed two very poor examples of exercising judgment and principles.
Dude, I'm not condoning what they're doing in any way. I'm just giving examples of things that happen out in the "real world"... i.e. clinical practice. If you think things like this don't happen pretty much every day, then I don't know what to tell you.
What gives the impression of something "sounding reasonable"? Evidence. Every individual who has been shown (in vivo, in vitro, post-mortem) to have a condition has contributed to our knowledge. Your evidence is in front of you, in the patient, and behind you in the literature and lessons of every other patient who has ever had this condition.
The part that makes practitioners who they are is the same thing that makes architects who they are. It is that, often times, the "test"is the final product. Sometimes you only get one chance to build a structure that won't fall. But it doesn't mean that you don't still evaluate and draw conclusions. It is still a test of the theory.
CONCESSION: You ARE correct in an aspect you didn't mean to imply. All sarcasm and rudeness (on my part) aside. Much like architecture, the employment is somewhat artful. How you employ your knowledge is often a creative process. Also, getting your patient to elucidate all available information is an artful skill set.
But make no mistake, I am correct. You cannot give me a situation in medicine, even a creative application of medicine, that does not fit into the scientific method.
Oh, I get it. You don't understand the difference between Evidence Based Medicine and science.
Since you like to play semantics...
Are there other things to do on the internet?
Well, besides porn...
are there other things to do on the internet?
well, besides porn...
I'll ignore Beta's post for now, because... I guess because it is less well stated.
FYI she was talking more about physician authority and duty than the day to day aspects of the work. Of course most of medicine is the use of skills and application of applied knowledge. The question in this lecture wasn't how to classify medicine but where it derives its authority, and therefore who decides how much freedom it has, if any.
Her reasoning behind "medicine is not a science" seemed to be that physician authority is derived from society's decision to empower us through licensing and education funding. We, then, owe society back...and the implication was that we have no inherent authority.
That is not true though, because medicine was founded on reason and science. This was the original source of physician authority. Once the scientific benefits of medicine became apparent, and in more demand, then and only then was it turned into a "social obligation."
...which was a mistake, as Beta's post was the one in the thread that you needed most badly to address.
I'm guessing you must be MI/II, otherwise you'd have a little more of a clue. I'm all for EBM, but there are some parts of medicine for which it will never have more than a very limited scope.
He's correct. Medicine is a business.
*runs for cover*