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EDITORIAL

MEDICINE AND THE PEOPLE

OPINION polls show that, in general, people have a good opinion of doctors, though in some countries the rising rates of subscription to medical protection societies suggest that this affectionate gratitude can change to anger and a suit for damages. But law-suits are a small fraction of what happens in medicine. The practice of medicine would be simpler and more effective if the people had greater understanding of what we are likely to be able to do for their problem and where our help will be limited.

Proust said ‘To believe in medicine would be a great error were it not that not to believe in medicine would be a greater error still, for out of all its mistakes has emerged much wisdom.’ Since then surgery has advanced and the ‘miracle’ drugs for infections have emerged. Hope leads to a faith that there is a pill for every ill. The outcome is the belief that it is the pill that cures, and ‘the healing power of nature’ no longer gets the support we used to give it. The simplistic attitude that a pill or an operation will cure discourages the idea that effort is needed from the patient and his family.

I don’t suggest that asthmatics should learn auscultation. I do think people could benefit from simple knowledge of human anatomy and physiology. There is need for an understanding of the philosophy of medical science. People should understand that what we know is provisional and based on probabilities (so that we can simultaneously hope for remarkable benefit and expect very little). It would help too if they understood that symptoms and disorders do not have single causes but that many factors contribute. The doctor often has to keep in his mind a number of possible causes pending further information. However, lack of final knowledge will not prevent him using his skills to alleviate unpleasant symptoms.

The public’s understanding of the tentative way the physician’s thinking moves forward is impaired by the way in which the media usually presents knowledge. This is sometimes presented as a certainty, or two experts may be asked to present opposing views and the decision is arrived at not on factual data but because one speaker spoke up and the other mumbled. This is the legal way of

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making a decision, where one side must win and the other lose. Good medicine proceeds in the middle ground.

Doctors can contribute much to the campaign of educating the public. We can explain why, for a common cold, we suggest hot lemon and refuse to prescribe an antibiotic. We can refrain from dogmatic e.v cathedra statement and point out advantages and disadvantages of particular courses of action. Above all, we can try hard not to kid ourselves that we are wonderful or our methods magical.

RONALD MAC KEITH

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