What I fear the most

I’m going to hurt somebody, bad. Maybe even kill someone.

This unhappy thought keeps surfacing in my brain like the mechanized gerbil in Whack-A-Mole. It’s not an event I’m actively planning (my classmates and teachers can breathe easy). In fact, it’s something I’m dreading. But considering how common medical errors are, compounded by how often learners make mistakes, it’s very likely that I will harm someone, perhaps seriously.

My brain frames this fear two ways. One is a good, old-fashioned mistake, a constant threat no matter how hard you work to avoid it. In my prior job as a journalist, I put scores of pieces of information in each article. Each datum I tried to verify and double-check. Still, mistakes crept in: I would trust a faulty memory, misread my handwriting, copy someone else’s mistaken information or just suffer brain freeze. All these faults and more are likely to crop up in medicine, but the stakes seem higher – bad medicine is even more likely than bad information to kill someone. And though systems can limit some errors, such as replacing poorly scrawled prescriptions with electronic prescribing, mistakes always find a way to creep in.

One scenario bothers me more than a mistake. It’s the near certainty that I will actively do something to my patients, with good intentions, that harms them. I don’t mean a useful procedure that hurts, like a shot; I mean a pursuing treatment that leaves a patient worse off than if she’d never seen me. This fear flooded back when a lecturer discussing evidence-based medicine rattled off examples of once-admired treatments since shown to be worthless (e.g. knee arthroscopy) or affirmatively harmful (long-term hormone replacement therapy). The teacher recalled learning as a med student to treat ventricular ectopic arrhythmias with anti-arrhythmic drugs. Later studies showed those drugs increased death rates in such patients. The professor wondered aloud whether he’d killed any of his arrhythmia patients that way.

Some of the medicine I’m learning now is equally wrong. The problem is, no one knows just which parts are false. I have a hunch our ideas about the cause of mental illness will change with better brain science. I hope chemotherapy becomes a lot less savage. Maybe future docs will wonder why we’re so obsessed with Vitamin D. But we could be right on all those counts and stumble across some other fatal flaw in our knowledge. (I’m hoping for the future from Woody Allen’s Sleeper, where deep fat and hot fudge are health foods.)

The best we can do, our teachers say, is to measure the evidence for everything we’re taught and keep up with new research that changes medical knowledge. That’s a good start. It means the patients I hurt will suffer from ignorance that is widely held and carefully considered. I hope their survivors find some comfort in that.