A letter to my favourite genius, “Dr. Fred”, the best-informed family “Doc” I ever met: a lament (in which, for smoother wordflow, “he” is equivalent to “she”)
Dear Freddie,
With reference to the “Scandal in Portugal” we were talking about, in which a major percentage of heart failure patients died, essentially because they did not fit the proscribed guidelines: I am moved to write an Ode, or perhaps better, a Requiem, for medicine as we knew it – I hope you will appreciate the words below: please do let me know what you think!
Ode to Medicine, as it was and to my Fellows, as we were
“Medicine” has been intellectualised, theoritised and subjected to experimental, instead of experiential, “evidence”. “Evidence-based medicine” does not require, nor does it encourage, the intelligent analysis of clinical “findings” which we were taught to exercise.
As trainee-doctors, we were inducted into a cadre of free-roaming “lions”: we were kings of our jungle, recognized as such and respected by society for our strength, individualism, wisdom and expertise.
We were not Gods
We were not Gods, but we were believed to have a certain power over mysterious things: we were thought to have a magical ability, a flair for problem-solving, a dependable strength and a level of sympathy, empathy and honesty which was rare in our community.
We were respected, loved and blessed and we honoured each other, peer-to-peer. Kudos was accepted, acknowledged and graciously borne: our word, anecdotally supported and proven through experience, was gospel to the mass.
How things have changed!
But things have changed: our paradigm is but a memory!
We are now, to paraphrase Robert Burns, “Wee, Cowering, Timorous Beasties, with a panic in our breasties!
Our self-respect has died, along with our respect and our compassion (one might call it, “brotherly love”) for our peers.
Our camaraderie is no more.
Why is this? WHERE HAS OUR JUNGLE GONE? Are we not lions, still?
There IS an explanation: individual self-determination has been ground to dust by the inexorable progression of professional organization and the passage of control to central governance by “College” and “Association”, underwritten by big Pharma and overseen by our all-powerful Professional Gaslighter, the “Ministry of Health”.
The bureaucrats have re-drawn and re-defined our once-unlimited stomping grounds and relegated us, each, to his closed corral.
We still are lions, nominally; but we are not Gurus, as we were! Each space is populated by hordes of other would-be lions, many non-, or un-, professional.
Our actions are jealously supervised by legal eagles, each entitled, it would seem, to seize our trophies on a whim.
Our boundaries are marked by bureaucratic bramble, barbed and firm: we dare not breach our limits, for to do so is to risk our all-important “license”.
We are shackled, to (and by) our rules
In this new paradigm, we are shackled by instructions (euphemistically, “guidelines”).
“Evidence-based medicine”, governed by erudite, but clinically inexperienced “scientific investigators”, has taken the place of experience and anecdote. “Guidelines from on high”, the threat of litigation by capricious “clients”, judgement by newscast and eviction by edict have stripped our cloak of mystery.
We can be pilloried for poor handwriting, use of personal symbols in lieu of patients private details and in Ontario, even failure (God forbid!) to write “S.O.A.P.” in patients’ charts!
Our hard-earned clinical wisdom, “unsupported by evidence”, is viewed as suspect.
Our opinions, experience-based and proven in practice, are trashed, as “anecdotal”. Our observations are denied publication and relegated to the garbage heap.
In this new-world paradigm, we need not wonder that doctors, “wee, sleekit, cowerin’, timorous beasties” all, in kingdoms progressively invaded by “Nurse Practitioners”, “Knowledgeable Pharmacists” and other Designated Imposters, bend, capitulating to our “Guidelines” (issued from above, by professorial theorists who are short of experience and have no anecdotes to tell).
Follow the guidelines
Of course the modern doctor follows “Guidelines” – he has been trained that way.
Of course he fails to exercise his judgement: based upon experience, unproven by experiment and unsupported by theory, it is inadmissible in a court of law!
Of course he defers to tests and “specialists”: his experience has not been “proven” by ironclad, triple-blinded experiments, designed by scientists who have never seen a patient.
His conclusions and opinions, based on dedication and long hours, bolstered by thousands of interviews with intelligent citizens well able to describe their symptoms, are pooh-poohed by his masters.
Those masters are supported by their bureaucrats, the bureaucrats by politicians, the politicians by the press and the press by the media, all overseen by well-paid legal eagles who “recognise” the Guidelines as proxy “Lion Kings”!
Thus are we lost: too old, too weak, too debilitated, too downtrodden, too exhausted and in the final analysis, too disenchanted, to kick against the pricks!
Ah, So! My Guru, Freddie, Friend – please tell me – what say you?