I've been having a hard time believing in medicine recently. Sure I see the utility in repairing a laceration, giving some antibiotics, or taking out an inflamed appendix. But the other stuff. Like anticoagulation for DVT or acute coronary syndromes. PPIs for GI bleeds. The sorts of things that are standard of care, but don't add any measurable benefit. May even add some harm. I'm having trouble reconciling the fact that I am giving these medications to patients because Tis the standard of care. Yet I don't believe in them. I know lots of doctors do, but I'm not one of them. Do any of you tell your patients that anticoagulation doesn't help, but we do it because of theory and tradition-driven guidelines? Do I just wait until the guidelines change like it did for steroids in spinal cord trauma? Does anyone else feel this way? Does anyone care?
I feel like I'm looking out for myself (malpractice), often at the expense of the patient.
Yes, others feel this way.
Yes, plenty care, and are torn.
One of the most memorable things I remember from medical school, was a pediatrics professor telling us,
"A third of what you learn, you'll forget. A third will turn out to be completely wrong. A third will turn out to be right. And a there's no way to know right now, which third is which." (I added the last line).
So yes, much of what we do may turn out to be wrong. You and I may feel sure which those things are but we can never be sure. I try to accept the fact that I'm a good person, in an imperfect system, trying to help my patients to the extent I can.
As far as having doubts about certain standards of care, possibly being harmful. You may be right, or you may be wrong. However, I've reconciled that with the fact that the "standard of care" is determined by a legal system set up, by the people (your and my patients) and therefore there's a shared responsibility. As much as we doctors (
http://www.epmonthly.com/whitecoat/2012/08/a-nameless-faceless-killer/) have tried to get the word out that defensive medicine is harmful, the masses choose to maintain the status quo through their votes at the ballot box. So it's a shared burden. It's not all on your shoulders. If it was up to you, you'd scrap the medical malpractice setting we have so that you can take better care of your patients. But you can't by yourself. This is much bigger than you and I.
Take solace in the fact that you,
1-Are doing the best you can to help your patients, in an imperfect system that makes it hard on both you and them, and
2-Have patients that are lucky enough to have a doctor that cares.
Happy Holidays, to all.