Modern Medicine: let’s return to reason

N_JoshiNikhil Joshi is a Fellow in Clinical Immunology at the University of Manitoba. He wrote a blog for CBC about his experience with cancer

I was reading about Allergic Bronchopulmonary aspergillosis (ABPA) when it hit me.

Modern Medicine is taking a beating.

A day goes by in clinic. I’ve told three people today that the medications they are taking are keeping them from having uncontrolled asthma or an attack of angioedema and please not to stop them. I’m explaining that the disease is worse than the medications, which we give to children as young as 2. I sigh. I hate this. I scan the news headlines after my dictations are finished. I read about the NDP and Liberal party stances on physician corporations, which will probably lead to financial hardship on new physicians starting practice with entirely crippling levels of debt amid a background of rising overhead and reduced fee schedules. I’m further disheartened.

When did the world care so little about medicine? When did being a physician become so difficult and unrewarding? We, as physicians, have been the targets of egregious attacks. What is occurring in Ontario with the OMA and the government of Ontario is shocking. Our colleagues are being treated entirely unjustly and that should make us all pay attention.

‘I’m too tired’ I think to myself. And then I think that’s what we’re all thinking. We’re tired, stressed, but too selfless and committed to the system for our own good. What have we been thinking?

For too long we have been separated by our differences. Where we practice, what we practice. Our titles as surgeons, internists, general practitioners, etc. What is truly important is that we are doctors. We all took an oath and have chosen to spend our lives in the pursuit of healing the sick. For the life of me I don’t understand why that has made us targets. But I will say strongly ‘I don’t like this’.

I don’t like this because it feels like we’re the only ones fighting for the use of reason in a mad world. Why is there such hostility to our treatments such as vaccines? Can’t people appreciate the genius of the vaccine? How we use inactivated viruses to stimulate the bodies own defenses? Isn’t that amazing? How can someone not be in wonder of modern medicine? People are living longer, healthier and more fruitful lives. I treated an 83 year old man the other day who plays tennis for two hours a day! His life is full of joy he tells me. The hearing aid he was fitted with last week has made a tremendous difference in his life. He marveled at the new technology.

At the age of 27 I had Hodgkin’s Lymphoma, stage 2A, and received 4 rounds of ABVD chemotherapy. Was being a patient a cakewalk? No. It was the most difficult experience of my life. Having cancer is tough. But my life was saved and made better because people of all races and religions dedicated themselves to the pursuit of knowledge for the betterment of humanity. Someone actually did a trial on ABVD versus radiotherapy for the treatment of Hodgkin’s Lymphoma and that’s how my hematologist made my treatment choice. People who were going through what I went through participated in a clinical trial and that changed my life. How could I feel anything but entirely grateful? I’m reading about ABPA because someone decided to research it; they gave their limited time on this earth to building something for future generations.

We are at what seems like the top of a hill, and we can do amazing things with medicine. But no matter how many everyday miracles we perform the crowd just seems to yell, ‘More More!’ And then when we can’t make it happen fast enough they turn to charlatans slinging pseudoscience. I’m sorry if that’s politically incorrect - it’s true and I’m not apologizing for it because it causes harm. Spreading misinformation can cause suffering, and in most cases it is the innocent who are harmed, the way a drunk driver usually kills an innocent person who was loved dearly.

We have to insist on a return to reason. We have to stand up and say for the good of our patients, whom we promised to protect, we’re not going to live in a world without reason. We’re not going to let people make wild claims without having a scientific basis for those claims. We’re going to at least fight on the side of science because it is one of the best things about us as human beings - our desire to understand and help one another.

My favorite mentor once told me ‘the first step is to know if someone is sick’. What do you think? Reflecting on your practice, on the way medicine has changed since you became an intern; what do you think about the issues we face as a profession today? What should we do about it?

2 thoughts on “Modern Medicine: let’s return to reason

  1. Declan Fox

    On the other hand---maybe it depends on what newspapers you read. What TV news programs you watch. Who you talk to. Example. In England, the Daily Mail is a doctor basher paper. I don't read the Daily Mail. I read one copy, they give it away free on some domestic flights. Read one copy and you understand why they give it away free.
    On the other hand---my sense of what patients think of medicine, of medical care, of local services and of my practice comes from my patients. Way out here in rural PEI, they mostly appreciate good care and modern medical advances.
    Maybe you are getting a biased picture of what people in general think? As for political party posturing in the run up to an election---pshaw!! Election promises aren't worth the promises they're (not) written on.

    Taking the long view, I agree with Dr J about what is important in medicine for us as doctors. What is important is the interaction between the doctor and the patient, the sanctuary of the consultation. That is what is important about what we do. And that will go on and on, regardless of the foolishness of politicians or the need of trashy newspapers to make money.

    Declan Fox
    Family physician
    Tignish, PEI

  2. Charlotte

    I understand the motivation behind this essay, however it's difficult to tolerate much of it. It's important for people to recognise the amazing, lifesaving strides medicine has and continues to make. When in comes to vaccines, as you mentioned, there should be no room for debate. The same goes for life-threatening illnesses -- the risks of treatment often far outweigh the risks of the disease. That's said, it's also important for doctors to know when to prescribe less and listen more. I believe today's doctors are lacking in some very important interdisciplinary studies that would help them connect better to their patients. The very fact that you chose to use the word "races" proves this. ("Race" isn't actually a thing -- ask around.)

    You're speaking from a place of privilege and disconnected reasoning. Frankly, this whole piece (while perhaps unintentionally) comes across as arrogant.


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