Unconventional Wisdom

In many ways, being a Doctor is the worst thing that you could let yourself in for (despite what your parents may tell you!) and whenever College work-experience Students ask about the Profession, I invariably tell them to do something - anything - else with their lives whilst they still have the chance (unless of course, they are not going to be based in the UK). However, there are occasions when I am given to think that there may just be an upside to it all.

Perhaps the most valuable thing is the ability to think critically about a subject - and in fact I can think of no other vocation where you will be so utterly and mercilessly exposed to the extremes of humanity and have the opportunity to see how effective your blend of science, art and philosophy actually is.

The fact is that no-one really understands how the human body works. We only have a rough idea of how a typical person functions - and the differences between individuals are of a magnitude that constantly surprises me; most of the time we don't even fully understand how our medicines really work.

This is a scary notion that increasingly seems to miss the comprehension of most people.
It is comforting to think that if you have condition X,Y or Z then treatment A,B or C will be appropriate for you - but this is not always the case.

The only way to delineate what the right thing to do is therefore to use Scientific Evidence to guide decision making - but its only when you understand how science works and how evidence is produced that it can be grasped just how limited Evidence Based Medicine (EBM) is.


Nevertheless, this has not discouraged our political masters to introduce hordes of Nurse Practitioners to practice "cookbook Medicine" where they can huff and puff and vehemently argue that the "evidence shows this" or "the evidence shows that" without having any expert knowledge of the field or any ability to critically appraise that very evidence.

And, as in many other spheres, the evidence is often produced to support an argument that has already been formulated rather than in a spirit of genuine intellectual curiosity and, as in many other spheres, this reflects the conventional wisdom of the era.



In many ways, it is not in times of conflict that the greatest courage is seen; after all, if the barbarians are at the gate, it is a relatively straightforward course to take up arms and repel them. There is no choice to do anything otherwise. It takes considerably more courage to forment a response when there is no immediately obvious threat and when the way ahead is uncertain and perilous.

The second situation arises many times during a medical career. Life, and medicine, are not straightforward and that is why medicine is hard. Are you the kind of person who wants to think for yourself rather than be told what to do? Even though you may be unsure, do you have the courage to do what you hope is right even when the consequences of making the wrong decision might result in the death or disability of a fellow human being? Are you ready to take an insane gamble with your career prospects, financial stability and family life?

If so, perhaps medicine is the job for you. If not, do something else - anything else.