Monday, June 02, 2003

Uncertainty in Medicine

Dr. Steven N. Goodman is an epidemiologist in Johns Hopkins University. Reading his articles about evidence-based medicine was turning point in my thought in Medicine. Though that topic was not original, he explained the matter in the best way. Here I quote some parts of his article Probability at the Bedside: The Knowing of Chances or the Chances of Knowing? in Annual of Internal Medicine, 1999;130:604-606
Consider what would happen to 100 identical copies of Mr. Smith if each underwent the operation, with a 40% mortality rate. Would 40 Mr. Smiths die? Or would all 100 Mr. Smiths either live or die, with 40% representing our uncertainty about which it would be? The first of these scenarios represents the stochastic interpretation of risk, implying that risk is a physical characteristic of Mr. Smith. In the second scenario, Mr. Smith’s fate is determined, and potentially explainable. What we are calling his risk is actually a measure of our incomplete knowledge: the degree of-belief interpretation. We cannot ascertain scientifically, which of these scenarios is true, yet our view affects how we manage patients, how we talk to them, and how we are heard.
He quoted an interesting part of Tanenbaum’s article entitled What physicians know in New England journal of medicine, 1993;329:1268-71.
Uncertainty is inherent in medical practice because patients present individual and complex medical circumstances. Physicians can never be certain how to transpose a biomedical theory or a clinical research finding to a particular case. In an act of interpretation, not application, physicians make clinical sense of a case, rather than placing it in a general category of cases. As interpreters, physicians draw on all their knowledge, including their own experience of patients, and laboratory-science models of cause and effect.
I will write more about this matter though I think many of you know this kind of challenge in every science.
(posted by Iman)

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