Two Basic Medical Rules
I've noticed on social media the spread of soft thinking regarding medical practice
There are basic things you learn in the first month of internship. Here are two:
A clinician should never order a test if the results (positive or negative) will not change what you do after the test.
All interventions come with potential benefits and potential harms. A clinician must match these to the individual being treated.
Much mischief occurs when these basic tenets are not followed.
That is it. This is the post. I cannot think of one exception to these rules.
As always, thank you for your generous support of this newsletter. JMM
Imagine how much it would have disarmed both medical authoritarian sycophants ("trust the science") AND rabid antivaxers if we had applied these principles to the pandemic.
Rule 3. The risk of life-threatening complication from a heart catheterization may be 1 in 1000. The odds of winning the lottery are 1 in 300,000,000. Your patient is checking the lottery ticket convinced they can win the lotto. The 1 in 1000 devastating stroke, that will happen to someone else. I used this exact example when I had patient sign the consent. Thankfully after 40 years and retirement no one died or had that in my case, but I watched a coronary tree dissection after the use of ergonovine something we used to think was a great idea. Not many remember those days.