May my surgeon be human-hearted

Screen Shot 2016-04-04 at 08.49.19Dalrymple points out that the media’s attitude towards medicine

swings between lauding a miracle cure and excoriating the murderous incompetence of doctors, leading to a dialectic between unfounded hopes and hostile suspicion.

Yet very occasionally it perhaps ought to be acknowledged that medicine,

for all its deficiencies and the carping of its critics, is a noble enterprise.

Doctors must act

in the absence of definitive knowledge. Sometimes this leads to tragedy, sometimes to triumph.

Screen Shot 2016-04-04 at 08.20.47A paradox

Everyone who comes under the knife

wants his surgeon to be as highly trained and as experienced as possible: but how is the surgeon to come by that training and experience unless he practises on people while he is untrained and inexperienced? Someone has to be operated on by tyros, even if they are under the supervision of more experienced surgeons. In practice, for compelling practical reasons, that supervision may be light: senior surgeons cannot be everywhere at once. What is true of surgery is true of other specialities: decisions of vital importance to individuals are taken by people who are still learning.

In the old days,

Thomas Rowlandson, 1793

Thomas Rowlandson, 1793

perhaps explanations of treatment options were less elaborate or full than they are today, but they were still given and consent to such treatments was still sought.

Patient autonomy as the single most important guiding principle of medical ethics has drawbacks.

Patients who are very ill are often in great pain, or severely weakened. Their concentration is poor, they may be irritable or in a state of panic. This is not generally the best moment to ask them for a reasoned assessment between two or more alternatives, each with its own advantages, side-effects and chances of failure. The insistence that they do so is often a form of disguised cruelty.

Dalrymple says that when he has been seriously ill or injured,

I have wanted my doctors just to get on with it as best they could, without any interference from me. So far, at any rate, my confidence in them has not been misplaced; and the paradox in the doctrine of autonomy is that the person may — in fact, often does — wish to abrogate it.

Surgeons

need human as well as technical understanding, and kindness is at least as important as respect for patient autonomy.

Advertisements
Trackbacks are closed, but you can post a comment.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s

%d bloggers like this: