Doctors as gamblers বিজ্ঞানের সব টেক্সটবুকের মতোই ডাক্তারি বইগুলোও খুব নীরস হয় । তবে কিছু ব্যতিক্রম আছে । বিশেষ করে অপেক্ষাকৃত জুনিয়র ডাক্তারদের লেখা কিছু বই । অক্সফোর্ড হ্যান্ডবুক অব ক্লিনিক্যাল মেডিসিন এরকমই একটা পপুলার টেক্সটবুক । দারুণ বুদ্ধিদীপ্ত ভাষা, রসবোধ । এটা শেয়ার করার বিশেষ একটা কারণ হলো, ডাক্তারদের সম্পর্কে রোগীদের অভিযোগের শেষ নেই । এটা পড়লে তারা হয়ত কিছু সান্ত্বনা পাবেন । Doctors as gamblers: To the average mind it is distasteful to learn that doctors gamble with patients’ lives. One of us (JML) has just finished consulting with 23 patients. Not too many, perhaps: it might be argued that each symptom, especially if serious, should be investigated until the cause is found. Let us look at this critically. What counts as a serious symptom? One that might mean death, disfigurement, or disability. Some of these patients offered 5 symptom groups before being gently dissuaded from going on. During elucidation of these symptoms others emerged, yielding a potentially endless cycle of investigation. Certainly some of their symptoms might not seem serious (“this pain in my toe…”). But toe pain might be mortal if caused by emboli or osteomyelitis. Fingernail problems with a slight rash might mean arsenic poisoning, lethargy may mean cancer, and so on. So medicine is not for pessimists—almost anything can be made to seem fatal, so that a pessimistic doctor would never get any sleep at night for worrying about the meanings of his patients’ symptoms. Medicine is not for blind optimists either, who too easily embrace a fool’s paradise of false reassurance. Rather, medicine is for gamblers: gamblers who are happy to use subtle clues to change their outlook from pessimism to optimism and vice versa. Sometimes the gambling is scientific, rational, and methodical (odds-ratio analysis): sometimes it is not, as when the gambling is based on prior knowledge (vital but illdefined) of one’s patient, or the faint apprehension of terror in this new patient’s eyes that shows you that there is something wrong, and that you don’t yet know what it is. Being lucky in both types of gambling is a requisite for being a successful doctor: after all we would all rather have a lucky doctor than a wise one. In this game, especially when it gets deadly serious, the chips are not just financial (the most costeffective next step). They betoken time (for you are spending yourself as surely as you are spending money, as you walk the wards), your reputation, and the health or otherwise of your patient. So do not worry about the fact of gambling: gambling is your job. If you cannot gamble you cannot cure. But try hard to assemble sufficient evidence to maximize the chances of being lucky. Professions allied to medicine often seem similar to medicine, but typically without this central role of risk-taking (midwifery is among the notable exceptions). The foregoing explains why courage is the cardinal clinical virtue: without it we would not follow our hunches and take justified risks—and all our other clinical virtues and skills (holistic care, diagnostic acumen, and operative dexterity) would not be deployed to their full advantage, while we pass the buck.
Posted on: Fri, 12 Sep 2014 08:02:01 +0000
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