We Have Changed

One of the most difficult aspects to practicing medicine (anywhere in the world) is uncertainty. The new mantra in medicine, and appropriately so, is "evidenced-based medicine". For some areas of medicine, such as cardiology, there are large randomized controlled studies that guide decision making. Even so, these studies generate statistical averages, and it is always hard to say if an individual patient will experience the statistical benefit, or the statistical harm. Many areas of medicine do not have these evidenced-based tools, and that is where experience and the art of medicine come to play. But imagine working as a doctor where even in areas of medicine where scientific knowledge exists, you don't have the means to bring the fruits of this knowledge to your patients. And so with some certainty you know your patient could have lived, only if they had the proper medicines. With more marginal cases, uncertainty still hovers, but much of that doubt is whether more effective tools would have made a difference. Then imagine you have doubts about being able to properly raise a family, providing an education for your children, or- in worn-torn countries- having basic security. But you are certain that a better life exists somewhere else. So you leave.