Heroes Not Zombies

From weather forecasting to medical prognosis, we love trying to predict the future.

We live in an ever changing universe, a universe which changes us and is changed by us.

Randomness, chaos and discernible patterns pervade our everyday reality. The constant interplay of structural “laws” and emergent new forms creates everything we can perceive.

I was taught “common things are common”, but “don’t hold onto your most likely diagnosis too tightly”. Learning both diagnosis and prognosis enables doctors to make the best decisions possible in the moment while continually observing, ready to change and adapt as the unexpected pops up.

But it’s not just a professional issue. Every one of us deals, for the most part intuitively, with these two forces – randomness and structure.

How do we do that? We make decisions based on reasonable expectations, experience and an acceptance of a certain amount of risk. When we set out on a journey we expect the train, the bus, the plane, boat, car or bike to get us to our destination. Otherwise we wouldn’t set off. When we encounter a cancellation, an accident or a breakdown we adjust. We adapt, alter our plans and carry on with life.

As a doctor I knew the importance of follow up and continuity of care – it was the only way to deal with the fact that no outcome can be guaranteed at an individual level. Just because a particular treatment results in a hoped for outcome for the majority of participants in clinical trials, we can’t be certain this person, this individual, will experience those same outcomes. We have to remain vigilant, build a long term relationship and change course whenever necessary.

It pains me to see the development of algorithmic medicine which attempts to squeeze individuals into preset moulds. Human beings are not machines and life just doesn’t follow fixed predictable paths.

Relationships and continuity of care are, and should remain, the bedrock of all clinical care.