Certainty in medicine: a moving target

Abstract:

In medical school students are often impressed, if not beleaguered, by clinical teachers with bold statements that they should never forget.‘Do not let the sun go down over a diabetic ketoacidosis’ or ‘Giving morphine to a patient will spoil the evaluation of an acute abdomen’are examples of frequently lectured, sometimes even apodictic, proclamations. Many of these clinical edicts, however, have turned out to be wrong with current insights. In my personal medical training, not even very long ago, we were taught that duodenal ulcers were due to ‘type A personality disorders’(as exemplified by taxi drivers), that patients with heart failure should never be given a beta-blocker, and that patients with type 2 diabetes mellitus could not develop ketoacidosis. All this turned out to be untrue as well, not based on any empiric scientific observation, let alone understanding of underlying pathogenetic mechanisms. 1 Nevertheless, many students, now practising physicians, remember these aphorisms and find it difficult to get rid of them. Despite all postgraduate educational efforts, state of the art lectures during medical congresses and continuous medical education programs, many doctors still believe that oedema in nephrotic syndrome is due to low albumin levels, that humans have an intrinsic and extrinsic coagulation system, or that diverticulitis or pancreatitis should always be treated with antibiotics. Obviously, we now know that all this is incorrect, as recent publications also in the Netherlands Journal of Medicine underscore. 2-6 And the list of once ‘true’but nowadays outdated medical knowledge is endless, as biomedical knowledge and its application to …

Año de publicación:

2013

Keywords:

Fuente:

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