Summer time is finally here in Oregon, and I will confess that I have spent little time on blogging. The sun is out, my kids are out of school and home from college, and really, who wants to spend their time writing when you could be on the golf course or at the beach with the kids. I say this as a mea culpa for what follows.
One of the saving graces in medicine is just how hard it is to harm people and how much trauma humans can withstand and survive. When I am on call for my partner I cover a Level 1 trauma ICU and the hallway leading to the unit is lined with photographs of some the trauma survivors. Over the years I have helped take care of many of these patients and I remember the extent of the injuries and the intensity of the care required to pull them through. Most of the survivors are young; it is the young who have the physiologic reserve to deal with the stress of injuries and their consequences.
Still, human physiology is amazingly resilient, especially of there are no co-morbid conditions to interfere with healing. With a little, and sometimes a lot, of support, I am constantly amazed at what people can sometimes survive. Modern medicine can pull people through who would have certainlu died 20 years ago.
There are two way to hurt people: what you do and what you do not do, the harms of commission and omission. Harm can be obvious with surgery. Oops, sorry I left my watch in there. I definitely do not have what it takes to be a surgeon. Or you can prescribe a medicine with a known side effect. Most SCAM’s, by doing nothing, are not prone to this sort of harm. Chiropractic and acupuncture are the notable exceptions, but even then it is hard to tear a vertebral artery or drop a lung unless the patient is extraordinarily unlucky. Of course one of the things you learn in medicine is that occasionally someone is extraordinarily unlucky and has a rare, but not unexpected, complication of an intervention, SCAM or otherwise. (more…)