The Laws of Medicine: Field Notes from an Uncertain Science
Mukherjee, Siddhartha
Primary Category:
Literature /
Nonfiction
Genre: Essay
-
Annotated by:
- Miksanek, Tony
- Date of entry: Nov-16-2015
- Last revised: Nov-17-2015
Summary
This thoughtful essay from the author of The Emperor of All Maladies expounds on information, uncertainty, and imperfection in the medical setting. The author recalls witnessing a difficult operation when he was a medical student. The attending surgeon admonished the operating room team, "Medicine asks you to make perfect decisions with imperfect information" (p.5). This essay is constructed around that idea as the author shares three personal principles that have guided him throughout his medical career.
Law One: A strong intuition is much more powerful than a weak test. (p. 22)
Law Two: "Normals" teach us rules; "outliers" teach us laws. (p. 38)
Law Three: For every perfect medical experiment, there is a perfect human bias. (p.54)
He views the medical world as a "lawless, uncertain" place and stresses that biomedicine is a "softer science" than chemistry or physics. Clinical wisdom, in his opinion, is imperfect, fluid, and abstract whereas the knowledge base of other basic sciences is concrete, fixed, and certain. He laments, "My medical education had taught me plenty of facts, but little about the spaces that live between facts" (p. 6).
Law One: A strong intuition is much more powerful than a weak test. (p. 22)
Law Two: "Normals" teach us rules; "outliers" teach us laws. (p. 38)
Law Three: For every perfect medical experiment, there is a perfect human bias. (p.54)
He views the medical world as a "lawless, uncertain" place and stresses that biomedicine is a "softer science" than chemistry or physics. Clinical wisdom, in his opinion, is imperfect, fluid, and abstract whereas the knowledge base of other basic sciences is concrete, fixed, and certain. He laments, "My medical education had taught me plenty of facts, but little about the spaces that live between facts" (p. 6).
His own "laws" of medicine are actually laws of imperfection. Clinical diagnosis can be thought of as a "probability game" where human bias creeps into the process. And ultimately common sense trumps pure statistical reasoning. Woven into the discussion are considerations on a variety of topics - children with autism, Heisenberg's uncertainty principle, genomics, radical masectomy, and randomized, double-blind studies. Nods to Lewis Thomas (The Lives of a Cell: Notes of a Biology Watcher), Thomas Bayes (Bayes' Theorem), and Johannes Kepler (Kepler's Laws of planetary motion) fit in nicely with the thrust of the treatise.
Primary Source
The Laws of Medicine: Field Notes from an Uncertain Science
Publisher
TED Books/Simon & Schuster
Place Published
New York
Edition
2015
Page Count
70
Commentary
Maybe medicine is destined to remain a "softer science." So be it. Even as medical data improves and veers toward perfection, human beings (patients and physicians) will remain fragile, flawed, and emotional. There is no algorithm for the perfect doctor-patient relationship. Each one is unique and hopeful, precious and precarious. Uncertainty and imperfection fused with clinical competence, compassion, and conscientiousness make the practice of medicine both something less than hard science but something greater too.
A companion TED Talk by this author titled "Soon we'll cure diseases with a cell, not a pill" is available (free) at www.ted.com/talks.