On the abstractness of medicine
The practice of medicine is abstract. The definition of abstract can be nuanced and debatable, but in this case abstract is something that I can’t measure, touch, see, or use my senses to know it’s real. The past and future is abstract as it only exists in my mind. What I can sense now is not abstract, but real. Some work, like medicine, is done based on abstract ideas, while other types of work is limited to reality.
Home improvement projects for example, are closely tied to the present reality. This has been top of mind recently while dealing with a new home purchase that’s been requiring a lot of work. Though I don’t look forward to dealing with plumbing issues, I find the practicality rewarding. If the water pressure is low, I work through the problem areas starting with the aerator, until I find the obstruction. Then it’s fixed. It’s predictable with immediate results. I can see it and feel it.
This is in contrast to my day job. The practice of medicine for me deals with reducing the risk of death and disability in the future. When someone takes a statin for primary prevention, the proposed benefit is on the order of 1% risk reduction of a heart attack/stroke in 10 years. And even this probability of benefit is an extrapolation with low certainty. Either way, the future itself is abstract and I will never know if recommending a statin helped that patient.
Studying medical interventions is difficult because the body is a complex system. Manipulating complex systems lead to 2nd, 3rd and 4th order consequences that can’t be predicted. Opening a clogged coronary artery with a stent to restore blood flow seems like a great idea. After all, it works for the bathroom sink and we’ve got a physics formula to tell us what we need to do to improve flow. But studies show no difference in clinical outcomes of stenting open coronary arteries outside of emergency situations, even when flow is restored. Trying to reduce the complexity of the human body to a simple function leads to being fooled. And thus, questions of intervening on the human body are less based on practical physics or chemistry, but are more of an abstract idea.
Despite dedicating a lifetime to helping patients, I’m sometimes left wondering what a retiring physician has to show for it. How many lives did he really save? What about harm? Have the countless deliberations about harms/benefits of aspirin, a low dose over-the-counter medication, ever made a difference? Unlike the plumber who knows that his work led to water flowing strongly from the sink, the physician will never know if he has produced anything.
At the end of the day, a retiring physician can’t see the life-years he’s prolonged, or the harms he’s prevented. If God were to do an audit of all the patients a physician sees in his career, I wonder if a net benefit would exist. I suppose then that medicine, being abstract, must be practiced on faith. Faith that what we’ve been taught is true, and the studies that suggest efficacy of an intervention were done correctly, were reproducible, and can be applied to the patient in front of us.