I suspect that the vast majority of us know very little about how one becomes a doctor that hasn’t been informed by TV shows. We expect doctors to diagnose like Dr. House or care for us like Dr. Dorian or entertain us like Patch Adams. Anyone who’s gotten a whiff of medical school will be quick to correct our misperceptions, but there are only a few doctors who are bringing the mysterious inner workings of practicing medicine to light for the general public. Atul Gawande is one. The late Oliver Sacks was another. Siddhartha Mukherjee is a relative newcomer to this part of the literary world. His first book, The Emperor of All Maladies, won a Pulitzer in 2011. The Laws of Medicine is a less daunting book; Maladies clocks in at almost 600 pages. The Laws of Medicine runs to less than 100 pages, but it’s no less ambitious. I’d say that Mukherjee intends for his laws of medicine to become a quiet revolution in medicine.
Near the beginning of The Laws of Medicine, Mukherjee comments that biology (and consequently medicine) is the messiest of the hard sciences. It’s hard to make many general rules about biology the way we can about physics, chemistry, or geology. Life is too messy and we still know so little about how it works. What I like about Mukherjee’s book is that he doesn’t go for platitudes. He really does try to come up with actual laws for medicine.
The laws revolve around diagnosis and research rather than patient care. Mukherjee looks back to Thomas Bayes‘ work on probability as a way to reduce false positive and negative results on tests. In lieu of any other option, a baffled physician might order expensive tests to figure out what’s going on with a patient. This seems like a reasonable strategy, on the face of it. More information must be good, right? But tests, with false results, can give too much information, and not always the information the physician actually needs to make a diagnosis.
Mukherjee’s other laws are similar, but they all revolve around the way a physician needs to think. Mukherjee frequently laments that new doctors don’t have the knack for assessing patients that doctors with years, decades, of experience have. New physicians are taught to rely on tests, on “hard science.” They’re not taught to focus on patient histories, environmental information, and other relevant data to rule out certain diagnoses and zero in on what’s actually happening with the patient. I suspect, unfortunately, that experience might be the only way to really learn how to diagnose efficiently. (Even then, doctors can make mistakes, as when it turns out that the hoofbeats actually do mean zebras instead of horses*.)
One might think that, being a librarian, The Laws of Medicine would be more a salve to my curiosity than something I might use professionally. Librarians are only rarely involved in life or death situations**. But I saw a connection in Mukherjee’s arguments about how we need to think and how librarians argue about information literacy. It’s not enough to have mountains of data. One has to be able to figure out what it all means. This is a fantastic book.
I received a free copy of this book from Edelweiss, in exchange for an honest review. It will be released 13 October 2015.
* From a reddit thread entitled “Doctors of reddit, what’s something you’ve had to tell a patient that you thought for sure was common knowledge?”
** A student’s paper being due at the end of the day doesn’t constitute an emergency. Not for me, anyway.