Are we all just shitty doctors?

The COVID epidemic has led to more self doubt among doctors than I’ve ever seen before. Normally, we physicians are not the most humble group of people. But the death that we’re seeing in spite of doing everything right makes many of us question the most basic parts of our clinical and professional skills.

10 years from now, half of everything we teach you will be wrong, we just don’t know which half

At the beginning of medical school, everyone hears a variation of this sentence. The point is about the inherent uncertainty in the progress of medical and scientific knowledge.

So you hear this concept as a first year medical student. And then you laugh about it because someone old told it to you, and you just assume that they just aren’t up to date the newest way that things are being done.

And then you go ahead and fully immerse every part of your being into the acquisition of state of the art medical knowledge. Then you start taking care of patients and learning how to navigate the hospital system to get your patients the care you need. You’re fully a part of the medical system now, and you develop a trust in yourself and your colleagues that we’re all doing the right things for our patients.

As a result, humility and skepticism sort of evaporate away. You become conditioned about the “right” way to care for certain diseases.

But then something like COVID comes along.

Science doesn’t work like that

I see a lot written about “scientific facts” and memes about “because science.” But that’s not how it works. We don’t figure something out and then it’s truth forever.

The scientific method is about either raising or lowering our confidence in a prediction about the natural world. It doesn’t establish fact. And I think Indiana Jones said that if you’re looking for truth, there’s a philosophy class down the hall.

We spend so much time in medical training learning the way to treat different diseases, and most of the time, patients get better, so we think our treatments are working.

It’s been attributed to Voltaire that, “the art of medicine is consists of amusing the patient while nature cures the disease.” COVID is teaching us just how true that statement is.

COVID has turned many of us into therapeutic nihilists.

And yes, it is exhausting.

I’ve talked before about how we’re seeing all kinds of strange complications in COVID - blood clots, renal failure, cardiac dysfunction - which is exactly what you’d expect when thousands and thousands of patients have the same disease.

But if we know how to treat ARDS, and we know how to treat renal failure, and we know how to treat blood clots, why are so many patients dying?

Are we just doing a shitty job?

Medicine gets more humbling the longer you do it. You see more biologic variation that doesn’t fit with your mental model of a disease process or human physiology.

And a new disease like COVID re-humbles us all over again.

It’s great that most people who get infected get better. But the ones who don’t get better are the patients we think about when we get home and whose bad outcomes invade our dreams.

Doctors are questioning some of our basic assumptions about the “right way” to treat this disease and its complications. This process promises to have a lot of bumps along the road, but ultimately progress and hopefully better patient outcomes as we learn more about which half of our knowledge is wrong.