Thursday, February 14, 2013

My Diagnosis of Medicine: Imprecise

(From the February 14, 2013 Grand Haven Tribune)

“Everyone is different.” We joke about it now. But it is the summary of my wife’s and my own frustrations with modern medicine.

We anticipate hearing that line in doctors’ offices now. We can finish a doctor’s sentence when we ask a question to get at some level of certainty about my wife’s current medical status, reaction to treatment, or future prognosis.

They just don’t know. They, in their impressive white coats and framed medical degrees, can’t give a definitive and precise answer.

I don’t really blame them, now that I’m more intimately aware of medical research and treatment related to my wife’s fight with cancer. But previously, without this experience, I had a notion that medicine was a field of scientific precision. I thought that when you ask a question of a medical doctor, after submitting yourself to a series of invasive and high tech tests, that you could get a very clear and specific answer.

You don’t always get that.

You do get a lot of qualified answers, full of soft words like “might” and “maybe” and “could” and “hopefully.” Then, when you ask why you don’t get more of a solid answer, you get....wait for it.... “well, everyone is different.”

That means the human body is not a machine. All our moving parts vary from one person to another. For all the medical research, for all the rigor of scientific process, it is still not possible to say that if you take this pill, have this procedure, adopt this diet or whatever, that you will be cured without question, 100 percent.

I also am a doctor, although not a medical doctor. As a PhD working as a professor in a field known as social science versus medical science, I study human behavior, which is more dependent on variables like attitude, value, social structure and so on. In social science, we would consider it preposterous to predict that 100 percent of a certain class of people will change their mind or act a certain way based on a certain circumstance. Instead, we look at percent response, variation in response, and multiple causes to the studied effect.

But I had thought that in science, what we call hard or physical science, there would be more straightforward relationships. But only in certain areas of study can things be predicted with absolute certainty, in what we call not theories but laws. The law of gravity in physics is an example. But I was naïve to assume that such laws governed medicine.

This reality bears itself out in multiple ways. Not all doctors agree. Articles come out that contradict long-held understandings of medical causes and treatments. Patients have to weigh the risk versus benefit of treatments, and whether the side effects of a treatment are worse than what they are supposed to be curing. This is another case where “everyone is different.”

One thing we have noticed in all of this is the importance of the softer skills in the middle of medicine. The skills and concepts taught in my field of public relations and communications, and its specific application in the field of health communications, for example, is what really sets apart doctors’ offices. Their staffs, from the receptionist to the nurses and physician’s assistants, and sometimes the doctors themselves, are the real difference makers.

We have been in situations where the two extremes of health care communication have been in evidence. In some, my wife has felt like a number, asked to fill out information for the hundredth time that they should already have in their system. Repeating her birth date so the medical professionals know they are talking to the right person. We have had to remind them that something quite important needed to happen in the RIGHT side, not the left. They seem annoyed when we ask questions, expecting us to be like lambs and submit to their care, in spite of the lack of precision and our experience with mistakes. I, meanwhile, have been all but ignored as someone who is not a patient and somehow, even though I am going through all of this too. This is why my wife introduces me as Dr. Tim Penning.

In other medical offices, the staff smiles when we enter and greet both of us by name. They remember that my wife likes to be greeted by her short name or nickname, and not her full given name. My wife has fond nicknames and inside jokes with some of these people. They remember aspects of her life and personality and ask about them. They even remember me and greet me by name. They spend ample time answering questions and putting us at ease.

In this context, even thought the medical science may be imprecise, at least we have a level of comfort and camaraderie to make up for the lack of certainty. I thank God for doctors and medical professionals who work hard and are continually making progress to understand and fight disease. But I have come to be especially grateful for those in medicine who see each patient uniquely, with unique diagnoses, personalities, life situations, concerns and faith perspectives. They see patients as fellow humans, not as medical cases. That’s why such people are making a difference: they are responding appropriately to the fact that “everyone is different.”