The brain remains our sexiest organ- only if turned on.

'Inspired' by an article from the BMJ:Table is Bru'd and Colgated( kaapied and pasted).Rest my inputs with occasional sprinklings of the writer's thoughts.

Common medical mental failings

Attitude:


Resistance to change

Cynicism

Lack of empathy

Intellectual tiredness

Emotional froideur

Cognitive function:

Failing memory

Irrationality

Erratic performance

Humour:

Outright failure

Relentless levity

Illiteracy:

Numbers and statistics

Emotion

Culture and literature

Language

Creativity:

Lack of ideas

Lack of opportunity

Workaday triviality

Put monkeys in white coats and they lose their bananas.

Traditional medical thinking follows the chimps. Despite centuries of medical science and epidemiology, we itch to name things, to define discrete categories, and to treat syndromes as entities. We automatically regard association as causation- maths was our least loved subject and we took biology in Std XII to escape the differentials and parabolic equations- and overvalue repetition in chance events.Occam's razor is an over taught rule and TB can cause everything except pregnancy is a joke we all hear from medicine residents' clinics. Even clever doctors make the usual errors in probability calculations.Thats all geeky stuff. We docs are hardworking guys who pride on learning hands on , rather than minds on.Flesh and bones and blood is easier to appeal to imagination and more romantic ( gee those TV channels where God plays the doctor's role- and not vice versa) than some Schroedinger's cat and Sine theta upon Cos theta equals Tan theta.

Its a tradition thing.
Its like the all appealing American sport concept..sunday evening is football where 200 pound hulks will wrestle for a oval football( oxymoron of sorts- balls aren't ever oval are they, ball never touches foot)while pretty girls dance in colorful skirts while people watch over chips and soda.Sunday evening cannot be any different. Its the ultimate dumbed down all conforming concept that can be.Tennis and soccer are for girls, who plays cricket anyways. Ball game equals you know what.If you mean something else, you are such a jerk.Similarly medicine is a tradition thing- as hallowed( love the way it rhymes with 'Hollow')as hallow can be. Medicine has to be the way it has been taught for centuries- anatomy and physiology doesn't change. Why should doctors?

Should a medicine man be creative then? Thats something of an antithesis.To be creative one has to have nothing to lose mentality for things.A human life can't be possible at stake- you can't have designer surgical scars or creative drug therapy.Its not what we are taught.We are taught to get by on pattern recognition, regular routines, and lists of things to do - techniques that do at least work but are rather less than our sporting best.Where is the scope for creativity?
Creative people are not necessarily reliable, and predictable chaps are not creative. But doctors are supposed to be both safe and adaptable.

So then, you would argue,is there a dumbing down of sorts, a waxy flexibility not allowing for laterality in thought.Maybe not. I have had the liberty of learning by trial and error during residency at KEM- litigiousness is the last thing to exist amongst the killjoy plethora of miserable circumstance and emotion. Have given bromocriptine to my hepatic encephalopathy patients, done exchange transfusion for borderline indications in sickle quasi crisis situations, done a hash of a Le Veen shunt for refractory ascites patients, liberally used magnesium without serum levels, lavaged ET tubes with Ciplox solution, used a hair dryer to warm a hypothermic patient, half dosed people with Artesunate...many more innovative spontaneous need based interventions . I would not hazard to do that in this country. But these were still within certain limits of biological plausibility and ethical viability.They are not radically alarming or avant garde. There is not a relativity theory or a abstract thought process yet in medical management protocols.

Protocols, protocols!!...well-since I uttered- In making protocols for management we are risking not making use of our brains to the complete extent possible. Think of the most cerebral event in managing a patient- is it writing the right side orders, interpreting test results? Or is it deciding when to change to plan B, racking your brain running out of differential diagnoses, figuring the mechanics of multivalvular disease or the etiology of that stroke from the semiology of events tracing the path of that embolus, explaining asymmetry in the hypothesis testing of the iterative process.People who have worked in wards will know what to pick.Prof Louis Aledort had mentioned at a conference in Mumbai- " the most enduring thing that keeps me from getting tired of getting up everyday and going to work is seeing, almost unexpectedly, an interesting patient or an engaging case discussion that will make all this worthwhile."

Dr Aledort's words reinforce the theory of Use it or lose it.
There are encouraging initial steps
- evidence based medicine, gives method to mayhem( remember the third adjective used in the definition of EBM is 'judicious'!!)
- medical wikis and blogging - a Medicine 2.0 of sorts
- the recognition of the concept of need based medicine is a first victory in some ways
-'appropriate technology'
-inquisitive trialists and liberal FDAs- will have their problems, but also gains to accrue.

One should appreciate the fact that successful doctors of the future will have to extend their development beyond their short spell of formal specialist or general practitioner training. Clinical and technical proficiency has to be achieved in the time available; but a full medical life will require more in the future and over its full span.

That cartoon has a reference btw:
Hangwi Tang and Jennifer Hwee Kwoon Ng
Googling for a diagnosis—use of Google as a diagnostic aid: internet based study
BMJ, Dec 2006; 333: 1143 - 1145