Sixteen years ago I posted an entry on this blog in which I suggested an anti-hubris courses ( or at least a few lectures) for medical students.
I did not have all the content of this course prepared (and still have not) but I do have the sense of it and some great quotes which I will sprinkle below.
Our approaches are provisional and based on fragmentary information and when I think about the algorithms and paradigms that are in our tool boxes, Boris Pasternak's quote appears as an emphatic "yes..but", "What is laid down, ordered, factual, is never enough to embrace the whole truth:Life always spills over the rim of every cup". Karl Popper said " we know a great deal but our ignorance is sobering and boundless...all things are insecure and in a state of flux".
All of this does not mean that we can't pull out the latest guidelines from whomever on our smart phone and see if that does or does not apply to the case at hand.But the operative words there are "see if it applies to the case at hand." The experienced physician has one- at least one-advantage over the younger one, he has seen the 180 degree changes in a given algorithm or clinical guideline. Plaintiff attorneys are fond of saying to the expert witnesses ,"Doctor,were you wrong then or are you wrong now" in the situation where there is an apparent contradiction.
Medical students need to know-in regard to the "factual knowledge" imparted to them- that while that material may be the very best that the very best of minds can determine at this time that they need to stay tuned because all of that may change at any time and the physician will have to decide what to do for the patient even before the next authoritative pronouncement is prepared.In that decision she will have to call upon her knowledge,expertise and judgement and the patient's values and views and do her job the way physicians have for many years before guidelines were part of medical language and work with the patient for their particular clinical truth.
"Life is short,the art long and judgement fallacious." is a hard quote to beat.