Medicine: An inexact science

“So, Talal, what is this structure that is passing through the diaphragm at the T-10 level?”

“The Oesophagus, right”

Heads nodded sagely in agreement. Professor X, in our recent anatomy oral exam/viva, had questioned me about a structure that I could indubitably recognise as the Oesophagus. Being cavalier as I was, however, I replied back promptly, and with a hint of confidence underlying my response. As I would in my day-to-day vernacular, I added the “right” after my response, scouting for an affirmative nod from the professor’s end. Yet, it was everything but that single affirmative nod that followed, and anon a profound conversation elicited.

“As an aspiring physician, you ought not say ‘right’ after your sentences,” explained the professor, and then duly continued, “You see, even after years of teaching anatomy and dealing with patients, I cannot be a hundred percent sure if my diagnosis, in a given scenario, is in fact correct.”

“What do you mean, professor?” questioned I, involuntarily fomenting a befuddled expression on my face.

“Medicine, contrary to the ubiquitous belief, is not an exact science; in a myriad of situations, exceptions occur, and as they do, they challenge all that we have spent our lives learning. In that light, and within the same context, we refrain from ascribing a hundred-percent surety value to our knowledge and, in turn, to our diagnoses.”

Word-bound, I glanced around the anatomy room; the gears of clock seemed to have wound down. Amidst the regular-Friday hubbub besieging the surrounding anatomy room tables, I fell into a reverie of brooding and introspection, and as I did, the present noises relegated to a virtually inaudible, indistinguishable murmur.

Lost within the academic world, and consumed with a quest to learn the underlying scientific principles, premedical and medical students often take for granted the fact that medicine, with all its intricacies and complexities, is an exact science, and one that does not, in its own right, require investigation beyond the prescribed SOPs.

But as soon as one interacts with and scrutinises real-life cases, it becomes conspicuous that medicine too, like the arts, is abstract. For instance, in a recent extracurricular book that I read, I noticed that in the case of Mr. P, an elderly gentleman, abnormal “D’ Dimer” values—values that insinuate toward the chances that a patient has a pulmonary embolus or clot—did not in fact correlate to his having a clot. Instead, the abnormally high D’ dimer values had been caused by a leg-fracture and profuse internal bleeding—factors that physicians had hitherto not considered as main contributors to raised D’ dimer values.

Regardless of Mr. P’s eventual prognosis, however, it is exceedingly obvious that D’ dimer values, which by all means are a very objective means of measuring the likelihood of an existent pulmonary embolus, do little to yield a definite answer: at best, they only point toward the remote chance that a patient might have of actually hosting an embolus.

In occasions like these, words often fail, knowledge feels scarce, and objective medical screenings and procedures even more so. In times of such quandaries and befuddlement, uncertainty governs the hospital wards, and heaps of notes regurgitated in medical school seem to afford no fecund advantage. Yet, it is within these same times of ambiguity and uncertainty that medicine finds its inveterate thrill: to appreciate one’s knowledge, to understand its limitations, to connect the dots and, most importantly, to eventually find that last piece in completing the abstruse jigsaw puzzle that is the human body.

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