The Art of Medical Science

Today I had my ERCP procedure to remove the 2 stents that were in my bile duct and put in a new one.  These stents are temporary and need to be replaced after about 8-10 weeks.  As I have mentioned in previous posts, my gatroenterologist, Dr. Kulkarni, had been trying to stretch out the bile duct to deal with what we thought was a benign stricture.  Having found the tumor, we decided there was no reason to try and continue to stretch the bile duct.  So instead of putting in 2 more stents, Dr. Kulkarni only put in a single stent.  The result is that I was under anesthesia for a shorter amount of time and I (seem to) have recovered more quickly than in the past.  My next appointment is with the medical oncologist on Monday.

As I was signing my consent forms for the procedure today, I began to think about what the forms said.  Essentially, the surgical and anesthesia forms said that while the doctors will do everything in their power to avoid problems, sometimes unforseen problems occur.  I tend to think that in science, we are able to predict things pretty well.  If I mix chemical A with chemical B, we get a predictable reaction.  This is not the case with medicine.  If medicine were JUST science, then the experience of the doctor would not matter. 

So in the end, the best doctors take the medical information they have and combine it with their experience and make the best medical judgments they can.  Often they are right, but other times they are not.  In our society of “sue first; ask questions later” I think that people expect doctors to be perfect when, in fact, they are only human (despite what surgeons think of themselves). 

Over the past several weeks, people have asked me “How is it the doctor’s didn’t find this tumor until now?”  I answer them by saying that back in August, the CT scan did not show a tumor (though, it might have shown up had I been able to keep the contrast down).  During the months that followed, my gastroenterologist told me that my body was not acting like I had cancer and the tests kept coming back either negative or inconclusive.  As a result, there was no real reason to pursue that diagnosis.  It was only after my bile duct was not responding to treatment that we decided to look for other possible causes and the tumor was identified.

The doctor’s did the best they could with the available evidence.  However, my case emphasizes the ART aspect of medicine over the science aspect.