Practice makes good enough.

NOVEMBER 5, 2007

“I had never done this surgery before,” my preceptor said as he pointed to the MRI on the screen. “I read about it in a journal. Didn’t turn out quite as well as I hoped. But next time I’ll read up on it some more and hope for better.”

As all things in life, practice makes perfect. Medicine uniquely requires one to practice on people. To further complicate things, medicine is always changing. Always improving. Of course, nothing in medicine is ever introduced without extensive testing to guarantee the safety of the people we treat. But eventually, every doctor has to make the jump and attempt that new treatment or new procedure. What happens to those first patients? Their results may be “not quite as well as we hoped.” Our patients unfortunately have to be the guinea pigs.

Even though I was not present for the conversation between my preceptor and his patient prior to the surgery, I can imagine somewhat how it may have transpired. He would have sat the patient down - explained all options. That a current surgery may exist which can help them. That he does not have experience with that surgery. Of course, many people put a great deal of trust in their physicians. When my preceptor explained “I have never done this surgery before,” many would likely hear “but I have done many surgeries like this before” as an unspoken affirmation. How close is that to the truth? How much does previous experience translate to future success?

Ultimately, I believe it is simply a matter of trust in the checks and balances in a system designed for change. As medical students, we bumble around learning the foundations of medicine that will help us function as the physicians of the future. In residency, we learn the skills and instincts that will help us succeed in the field we have chosen. New drugs and techniques are put through extensive trials. Surgeons travel to observe new procedures and read about them in journals. And ultimately it is all overseen by “experience.” Medical students are aided and corrected by the residents they work under. Residents are taught and covered by the attendings of their program. Surgeons learn from their peers who have pioneered and practiced new procedures. Drugs are tested and scrutinized by those involved and educated in their design and effects.

It may not be the best system, but it seems to be one that works. But with all things new, there are guinea pigs. Unfortunately in medicine, the guinea pigs are people, with the physician possessing only an instruction manual and trust in his or her skills and instincts to go on. This means people with "not quite good enough" results (which in reality in some cases means difficulties they will have to live with the rest of their lives). The best we can do is educate and hope for the best. Because it is ultimately about change, and change, as history has taught, is good for medicine. And good for the patient.