Having read two excellent books by Siddharth Mukherjee, that are ‘Emperor of All Maladies’ and ‘Gene – An intimate story’ I have become a fan of him
He reinvigourated by interest in biology which was kindled by Richard Dawkins earlier. This book, The Laws of Medicine’ is slightly different in focus in the sense that it talks about the dilemma, trials, errors and new knowledge gained by any doctor primarily due to his experience rather than strictly medical methodology and procedures. IT is an essay on his experience as a doctor which he looks at objectively as a third person.
There are immutable laws of physics and chemistry. But in biology, he suggests that there are surprises, discoveries, experiences with patiens which can only be described as successful by chance. Or where an effect of a medicine gives not anticipated outcomes but unencountered fatal consequences. Doctors have to face these kinds of situations in their routine. One medicine which resulted in wonderful recovery of a patient, may turn out to be dangerous for another patient, though the procedure followed in the same. Biology is not an exact science.
This book confronts the readers with the situation that trials and errors are the ways of medical practice and while there are set procedure for curing an illnesses you have to be ready for unanticipated outcomes. For example, medical tests designed so meticulously, may give correct results in 99 cases but the same tests may not give correct results in one patient. This may be a negligible percentage. But you cannot always be sure that in a particular case the results may be correct. You have to rely on other tests, other symptoms, or factors which existed which a doctor could not guess or anticipate. Interpretation of data is required. Here intuition works. Sometimes it may not work. But doctor has to decide. This is Doctor’s Dilemma.
Author gives an illustration. There was a patient who came with the complaint that his weight was decreasing without any obvious illness or pain. There was no fever, no pain and no symptom. Scores of tests did not reveal anything wrong. After many days, the doctor noticed the patient in the lobby of the hospital. HE was discussing something with another man. The other man’s dress/behaviour made the doctor guess his area of living. It occurred to the doctor that the area was famous for drug addicts. HE remembered that lab technician who drew blood from the patient had commented that the patient’s veins had all been pinched. The doctor connected the dots that the patient might have some connection with the drug users and the fact that his veins had been pinched many times. HE ordered tests for HIV and the blood tests confirmed HIV.
This books gives an useful insight into the minds of Doctors.