{"id":1040,"date":"2018-09-04T22:05:50","date_gmt":"2018-09-04T19:05:50","guid":{"rendered":"https:\/\/rovvm.ru\/?p=1040&lang=en"},"modified":"2018-09-04T22:05:50","modified_gmt":"2018-09-04T19:05:50","slug":"leonid-roshal-to-blame-a-doctor-for-a-mistake-in-a-decision-made-at-enormous-cost-means-completely-killing-the-profession","status":"publish","type":"post","link":"https:\/\/rovvm.ru\/?p=1040&lang=en","title":{"rendered":"Leonid Roshal. To blame a doctor for a mistake in a decision made at enormous cost means completely killing the profession."},"content":{"rendered":"

\"\u0440\u043e\u0448\u0430\u043b\u044c\u043b\u0435\u043e\u043d\u0438\u0434\"<\/a><\/p>\n

Medicine is philosophy.<\/p>\n

A medical scientist is called a Doctor of Philosophy. Medicine is a system of views on disease.
\nThere are hundreds of thousands of diseases, and the number of their combinations is endless.
\nThe laws of disease differ from the laws of physics.
\nThey do not fit into graphs and formulas. They cannot be described by a mathematical model or calculated even on the most powerful processor.<\/p>\n

In the laws of disease, there are exactly as many rules as exceptions, and the exceptions are so significant that they have their own rules.
\nAny third-year medical student knows that a heart attack can present like pneumonia, appendicitis like the flu, the flu like appendicitis, and gastritis like a heart attack, and that all these ailments can have a blurred or completely \u201csilent\u201d clinical picture.<\/p>\n

The laws of disease are not easy to fit into computer programs and clinical protocols.<\/p>\n

Medicine is a field of knowledge in which the patterns of diagnoses are brazenly violated by atypical symptoms, and disease outcomes are often unpredictable.<\/p>\n

Anything is possible here.<\/p>\n

In medical science, a fact is considered statistically reliable and proven at a five percent error rate. What does this mean? It means that even the most serious scientific evidence provides only a 95% probability of a correct diagnosis and treatment outcome.<\/p>\n

So, conclusion number one.<\/p>\n

A medical diagnosis and prognosis are never 100% accurate. Never.
\nNext \u2014 pay attention. In our advanced world, neither super-duper internet, nor a Japanese-super-Japanese robot android, nor a mega-nuclear-super-nuclear tomograph will diagnose you if your stomach hurts. Or your head.<\/p>\n

Even if you are capable of automating and subjecting your whole life to technologies and algorithms, a living person in a slightly rumpled lab coat will make the diagnosis.
\nAnd that diagnosis will have \u2014 at best \u2014 ninety-five percent accuracy.<\/p>\n

So, the diagnosis is made by a doctor. As it was a couple of hundred years ago, in fact.
\nAnd that is conclusion number two.<\/p>\n

Third. No doctor in the world is interested in complications or the death of their patient. Period. We accept the third point as an axiom and move on.<\/p>\n

So, 95% of diseases have a typical course: the symptoms are known, the tactics are worked out and prescribed by protocols: sore throat \u2014 antibiotic, peritonitis \u2014 laparotomy and antibiotic, bleeding \u2014 cesarean section. Or craniotomy. Depending on what hurts.<\/p>\n

The outcome of treatment is predictable\u2026 again, about 95%.
\nSo, fourth. In most cases, doctors treat you with confidence in the outcome.<\/p>\n

Fifth \u2014 those same five percent, damn them.<\/p>\n

Atypical, damn it, symptoms or a \u201cblurred clinical picture\u201d.
\nAn unexpected course of the disease or surgery. Or labor. A rare reaction to treatment.<\/p>\n

An unexpected combination of several diseases. It is in such situations that standard protocols do not work, and the doctor makes the decision practically alone.<\/p>\n

Switches the arrow \u2014 at the invisible fork in the road of your fate.<\/p>\n

Decides \u2014 operate or treat conservatively.
\nTake the baby to the operating table \u2014 or not.
\nDo a C-section or wait.
\nRemove an organ affected by a tumor, or preserve it; remove a hypotonic uterus or take the risk and not remove it.
\nHospitalize the child \u2014 or leave him at home.
\nWhether to go for a repeat surgery, whether to prescribe thrombolysis, and whether to bypass the brain.
\nIn many such cases, the risk of intervention is almost equal to the risk of no intervention.
\nSometimes you have a couple of days to make a decision, sometimes one night, sometimes a few seconds.<\/p>\n

And then he decides.
\n\u2014 is surgery needed for the child?
\n\u2014 there are anesthesia risks, intraoperative risks \u2026
\n\u2014 fetal intrauterine death \u2014 or a cesarean scar \u2026
\n\u2014 organ defect \u2014 or distant late metastases\u2026
\n\u2014 complications of irrational antibiotic therapy or a progressive septic process\u2026
\n\u2014 risk of contamination by a hospital-acquired infection\u2026
\n\u2014 risk of a lightning-fast course of the disease\u2026<\/p>\n

Risks, risks, risks\u2026<\/p>\n

And yes. Any treatment is costly.<\/p>\n

You may be surprised, but all this calculation, all the weighing, comparisons, and prognosis estimates, all the binary choices in such cases are based on a completely ephemeral substance: the doctor\u2019s intuition and experience.<\/p>\n

On some mystical trinkets from the magician\u2019s box, in short.
\nBelieve me, that is how decisions are made in the most difficult cases: in-tu-i-tive-ly.<\/p>\n

By eye. Heads or tails. Sink or swim.<\/p>\n

And if, for example, you happen to be among those five percent, consider that both sides got unlucky here: you and your doctor.<\/p>\n

Unfortunately, the math here is different: fifty-fifty.
\nIf the doctor draws the wrong card, that is what is called a medical error.<\/p>\n

It is precisely at this point, at the crossroads, that the doctor takes responsibility for the decision.<\/p>\n

Well, if the risks were equal from the start, it turns out the doctor will more often be wrong. And will come under a barrage of accusations, under a hail of criticism. \u201cYou should have acted differently!\u201d \u2014 they will shout at him on the internet, on television, or at a medical staff meeting.<\/p>\n

Now imagine what it is like to make a decision at such a moment. Try it, make it. Make a choice. With adrenaline, with a sweaty forehead. Next to asystole, next to clinical death. With a fist on the aorta. With three-tiered profanity echoing in the operating room. With sleeplessness, with tachycardia at the doors of intensive care. With sunken eyes. With a burden for the rest of your life.<\/p>\n

Imagined it? Exactly.<\/p>\n

The main conclusion. To blame a doctor for an error in a decision made at such a cost means to kill the profession completely. To make all this experience meaningless.<\/p>\n

Protect doctors.<\/p>\n

The younger generation is not going to be lured into medicine anyway.
\nLooking at the current witch hunt, soon no one will want to stand there with you \u2014 at the key crossroads of your lifelines.
\nEveryone will go into IT and web design. Or cosmetology.<\/p>\n

With smooth skin, you will sit at the computer and be treated on the internet. On beautiful websites.<\/p>\n

Unfortunately, I understand what kind of typhoon we are in…. I have long wanted to somehow summarize all the hopelessness of medical practice in our country, but there was neither enough time nor experience for such a deep analysis…. Try to make a mistake\u2014both the patient and your colleagues will tear you apart….
\nAnd how many cases of gross error, up to and including postoperative fatality, have there been in Germany, Israel, the UAE, South Korea….. I have several such cases in the much-praised England and the USA…. and what is most humiliating is the silence toward them… well, as if they did everything… they are Divine…
\nAnd it is also upsetting when people spend insane amounts of money on checkups abroad and, returning here, ask to review the studies performed….. of course, without payment….
\nMoreover, our consultations cost a pittance compared with the opinion of a Foreign Doctor… who did not even touch the patient……
\nIn the past, performers were in the role of jesters at courts. Doctors, however, were considered a very privileged estate! And now the jesters are us…..- those who work and live for our people!
\nBe sure to send this article to people who value the white coat, to your colleagues and grateful patients…. let them learn about the worsening attitude toward us and our life-saving profession.<\/p>\n

Leonid Roshal<\/em><\/p>\n

source:\u00a0http:\/\/www.noav.ru\/?p=7749<\/a><\/p>\n

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Medicine is philosophy. A medical scientist is called a Doctor of Philosophy. Medicine is a system of views on disease. There are hundreds of thousands of diseases, and the number of their combinations is endless. The laws of disease differ from the laws of physics. They do not fit into graphs and formulas. They cannot […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"inline_featured_image":false,"footnotes":""},"categories":[2],"tags":[],"class_list":["post-1040","post","type-post","status-publish","format-standard","hentry","category-news"],"_links":{"self":[{"href":"https:\/\/rovvm.ru\/index.php?rest_route=\/wp\/v2\/posts\/1040","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/rovvm.ru\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/rovvm.ru\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/rovvm.ru\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/rovvm.ru\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=1040"}],"version-history":[{"count":0,"href":"https:\/\/rovvm.ru\/index.php?rest_route=\/wp\/v2\/posts\/1040\/revisions"}],"wp:attachment":[{"href":"https:\/\/rovvm.ru\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=1040"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/rovvm.ru\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=1040"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/rovvm.ru\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=1040"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}