Reflections on Health & Medicine
Dr Gary McGowan
Later on today, I will be graduating from my medical degree, and I can gladly call myself Dr Gary McGowan. It's been a difficult road, and I am grateful for the support I received from the Triage team and our loyal followers throughout the process. When you have other people that have expectations of you, coupled with expectations of
yourself, it's much easier to push through on tough days.
Now that those 4 years have passed, it's amazing to reflect on how much my knowledge of health and disease has evolved, and exciting to think of how it will continue to do so in future.
With that in mind, there are a couple of reflections that I want to share that I feel will be of value to you, and we will also be elaborating on this in this week's podcast (to be released on Monday, May 29th).
Medicine is both an art and a
science, and there is uncertainty in all medical decisions. It is rarely the case that one can be 100% certain of a specific diagnosis, all relevant investigations, and the best management plan. It is also rarely the case that a response can be predicted, and there are always known and unknown risks of medical intervention.
When you elevate the Doctor, or Medical Science as a whole, to the level of a god, you may be let down to learn of these uncertainties. We saw this unfold throughout the pandemic. Often, public health experts spoke with an excessive degree of certainty, further reinforcing the perception of infallibility among doctors. We can understand why this happened, as the last few years have been a time of rising
institutional distrust, and speaking with more certainty than is warranted can be a means to override this, but only in the short term.
Long term, when those uncertainties expose themselves, you shoot yourself in the foot as a science
communicator, as the public can now clearly see that you are willing to express certainty where there is none. This then drives further polarisation, which we saw from beginning to end on topics of transmission, mask efficacy, vaccine efficacy, lockdowns, and more.
This exposé of uncertainty in medicine at the public health level was unfortunate, as there are many in medicine who believe that doubling down on their condemnation of the public is the way forward. Personally, I don't. The future of medicine, as I see it, is one in which we should make clearer the presence of uncertainty in decision making, which many doctors already do incredibly well. I've seen fantastic examples of this in practice.
For example, let's take something like cancer screening. The public often think that detecting more cancers as early as possible is a good thing, but not always. Many doctors do a great job of making clear to patients why excessive screening can cause harm, as in cases
of overinvestigation, overtreatment, and detection of ambiguous findings that may or may not have ever evolved to significant disease. But, this is far from intuitive for most people, and therefore, the medical profession should work to make clear the risks and benefits of not only treatment, but also disease screening and investigation in the first place.
If you are interested in this line of thinking, particularly the excesses of medicine, I recommend listening to this fantastic podcast I recorded with Professor Seamus
O'Mahony.
The ironic thing is that you want the doctor that says "I don't know", or "I'm going to get a second opinion", or "there's a 70% chance this will work, 20% chance of no benefit or harm, and 10%
chance of harm". These are the doctors that appreciate their own limits, the uncertainty in medicine, and act with your best interests at heart.
I hope that, wherever medicine takes me, I can be that type of doctor, both in my dealing with
patients one-to-one, and my communication of the science relating to health and disease here at Triage.
