A Few Thoughts by Stephen Vaughn MD, PhD

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One of the greatest dangers of the trend towards mechanical medicine is the crippling of the human mind and the way that we all think.  Computers are very capable of following a series of well-defined, discrete and inarguable facts through to absolute results.  2+2 = 4 in all huuman languages; (+ 2 2) returns 4 in every version of LISP the argument is offered.

Linear analysis of fact is only one of the several ways that humans think.  We have accepted the proposition that ALL human thought – not just algorithmic thought – can be modeled by artificial intelligence machines.  That proposition is absurd.  We think linearly, of course, but also in shapes and metaphors, in one human language or another.  Mathematicians can sketch out ideas in the language of mathematics, not requiring that every statement be made in a human language, but one that is universally spoken by all mathematicians.

Doctors who enjoy the linear, analytic side of medicine can derive great satisfaction from some of the branches of the profession;  others, who think in the myriad other ways of human thought, may enjoy others more.  When I consider the different branches of  Medicine, I often contrast Cardiology as a field with a certain affinity for exactitude and reduction, with Rheumatology, a branch that I find more intuitive and holistic.

Cardiologists make tremendous headway in their profession with contemplating blood flow in three vessels.  The more exact nature of cardiology does not mean that it is easier, or even more convenient to algorithmic modeling.  One just thinks differently about the diseases of this field in contrast to rheumatology, which has been described as “one disease with a thousand manifestations.”

I enjoy Internal Medicine, because it demands skill in all means of human thinking.  I have referred a scleroderma patient whose disease turned  lupus-like, and was actually mixed connective tissue disease; and patients I suspected of circumflex artery stenosis.  The language to each consultant was different, of course.  “The angina was undifferentiated and RCA-ish until it turned circumflexy” is a consult that will  raise the eyebrows of the cardiologist; “Sharp’s disease, anti-U1-RNP antibody not measured but I estimate it at 1:2500” is quite pretentious and a bit strange.

We have allowed ourselves to pretend that we view human health and disease through a pinhole; and yes, the world viewed through a pinhole is in focus.  But we have insisted that everyone go about life peering through their own small pinhole, which allows some things to be seen clearly, but others not at all.

Of all aspects of medicine, I think I am charmed most by the Diagnosis, the hunt.  I love referring patients for whom I have been the first one to diagnose a subtle illness and offer them relief.  It feels like the first explorer to see down from the top of some great mountain – I am not the first one to see it, but rather to see down from it.

That is a skill that only comes from years of study and care, through school and residency – there is no way to Google it.

The south Pacific was settled by navigators in wooden canoes, seeking a few square miles of land that five hundred miles across the monotonous and unchanging ocean.  It took a lifetime of ocean sailing and intuition to do this, with no compass, no astrolabe.  We can now read about how it was done, with some understanding of currents and birds, wind and weather, and try it ourselves.

Good luck with that.

Medicine, like open-ocean navigation in wooden canoes, is easy if you do not care about the outcome – which means that someone else will pay pay the penalty, not you.  Every generation has its fools – and every generation puts a few in power, to be sincerely regretted by the following generations who pay the price.  We are no different.  Here comes the deluge – you can now friend it on Facebook, and watch it on YouTube.

Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  7 comments for “A Few Thoughts by Stephen Vaughn MD, PhD

  1. Kathleen Hallinan, MD
    March 21, 2015 at 9:24 pm

    Well said. I find our EMR to be a degrading experience as it questions my ability to even decide that something as simple as giving amoxicillin to a patient with pharyngitis ought not be done without putting them through a rapid strep test. Every time I see the Yellow Exclamation sign warning come up, I want to take of my stethoscope and go work at McDonalds.

  2. politovski
    March 21, 2015 at 12:28 am

    love the pinhole camera analogy. but i would offer up that while everything through a pinhole may be in focus, it is not sharp and often fuzzy. perhaps an unintended extension of the metaphor….

  3. Louise Gold
    March 20, 2015 at 12:43 am

    I for one am eagerly anticipating MORE mechanical medicine. Doctors and researches are often loathe to share information which then results in useless tests and treatments. Egos get in the way.

  4. Bridget Reidy MD
    March 20, 2015 at 12:10 am

    well said. and also the comment about rheumatology, which can also be said for FP at its best.

  5. steven
    March 19, 2015 at 2:52 pm

    rheumatology remains as one of the few fields in medicine that requires a careful history, physical examination, and integration of laboratory parameters to the clinical scenario. not everyone with a + rheumatoid factor has ra, not every rheumatoid patient has a + rf; hyperuricemia does not equal gout, an ana is very non specific. as one of my mentors said years ago-“if after a careful history and physical you don’t know what the diagnosis is, all the tests you can order aren’t going to help you.” thing have changed some since then, with the advent of mri scanning and newer diagnostics-but the challenge remains to synch the clinical with the results.

  6. Victor G Ettinger
    March 19, 2015 at 10:34 am

    Inextricably arcane confabulations

  7. William FitzPatrick DPM, Cped
    March 18, 2015 at 8:33 pm

    Well said and a fine analogy of why medicine will likely always remain an art. I as the most humble of all practioners ( working at the very feet of my patients) have sensed but not been able to articulate your thoughtful analysis.

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