Tuesday, July 6, 2010

A few musings...

Science and medicine are not perfect. People are constantly shown the image of the all-knowing scientist or doctor. House, Bones, CSI, etc. paint a picture of people who know everything and can do anything. In reality, science and medicine are much messier.

I’m currently at the crossroads of deciding between a career in medicine, research, or the middle ground between both. I’m weighing the pros and cons of each profession. My father is a researcher and thus I have witnessed the stresses of grant writing, the uncertainty that comes with a field where you are searching for the unknown. My mother is the business manager for a group of doctors. I’ve heard the litany of woes that stem from budget cuts, insurance companies, and troublesome patients. My mentor, who I have been fortunate enough to have known since high school, is one of the few people who brave both sides of the field, in the clinic and on the bench. And he usually isn’t terribly thrilled with either. Through these connections, I have had a relatively unique experience and have been able to witness the less than rosy side of my chosen options.

I’ve worked in a lab of some sort or another during the summers for the past five years (with one year taken off to travel). I’ve had experiments go swimmingly. The procedures are clearly laid out and the results are exactly what we expected. The change in the DNA we wanted is there. It’s an amazing feeling to know that you’ve exacted a change in the very thing that encodes all life on this planet.
Yet, there have been the annoying problems. Something goes horribly wrong somewhere in the line and your entire experiment is held up for weeks at a time. Which, when put into the perspective of an 8-10 week internship, is over half the time you are there. The core process to your experiment suddenly stops working properly. And each run to troubleshoot it takes an entire week. A cell line stubbornly refuses to flourish in your lab. In any and all cases, you systematically eliminate each possibility, which is time and resource consuming. It is frustrating and you sometimes wonder if you should just give up and pick a new project.

My current internship is closely linked with a hospital and my mentor has taken me along on interdisciplinary conferences, where people in all fields are consulted for guidance on how to proceed with a patient. I was surprised (though I really should not have been) to learn that medicine has a bit of guesswork involved. For some people, they figure that they have survived X disease and Y cancer, so they just might survive Z treatment. Other times, physicians and surgeons fail to follow guidelines in the heat of the moment. They panic and do a sloppy job, leaving others to clean up the mess. They fail to document their actions completely, leaving the next doctor to just guess at what has been tried on or done to a patient. Hospital bureaucracy leaves those who see something wrong being done helpless to do anything about it. And this has become maddeningly commonplace, to the point of being banal. Attitudes become, “Well, we’re a backwater hospital and there’s not much we can do, so we’ll just forget about it and move on.” The only thing that can shake that attitude is the omnipresent specter of being sued for malpractice.

Now, I don’t want to seem like I’m just complaining about what I want to do as my life’s work. Both science and medicine are very rewarding. The best science and medicine take place when one gets as much out of failure as one does out of success. Rather than focusing on the negatives and getting bogged down and feeling sorry for yourself, you critically examine what did happen and adjust. Change is necessary. Admitting failure is necessary. Handling both is what sets apart happy professionals from those who are rather miserable to work with.

I’ve noticed that many people have trouble with is admitting that they don’t know something and for people to accept that scientists and doctors don’t have all the answers. Not knowing something is completely acceptable. With science and medicine, the number of things to know is so vast that no one person could hope to even know a fraction of it. You wouldn’t ask an astrophysicist a question about botany. It would be unreasonable to ask a GI specialist about a cardiac problem. If a doctor is confronted with a problem he or she has no special knowledge of, then he or she needs to swallow their ego and ask for help. At the same time, patients must realize that their doctor is human and can and will make mistakes. Now, this does not excuse gross negligence, but it would render many frivolous malpractice suits moot. All data is subject to human interpretation.

The underlying question that is then asked after hearing this less than flattering portrayal of science and medicine is, why? Why do perfectly sensible people subject themselves to these stresses? For most, it isn’t about the money. Scrabbling for grants against a very competitive group of people is not appealing. Most physicians are paid decently, but only in countries with private healthcare. In countries with nationalized healthcare, the compensation is not extravagant.

My answer to that question is that people want to make a difference, to leave a positive mark on the world. There is the drive to do good. Maybe not all scientists can be Watson and Crick, Jonas Salk, or any of the other well-known researchers. But they can at least contribute to the pool of knowledge from which another may draw an equally important breakthrough. Most physicians will not reach nationwide recognition, but perhaps they can save the lives of a few people. Or make many feel better and increase their quality of life.