ABC’s new reality show–if you can call it that–is already rubbing me the wrong way. It’s called Miracle Workers. (Here’s an article about the show with its host, a Miami CT surgeon. (thanks KevinMD). From the show’s description:
Each week, the show will feature two stories of ordinary people who do not have the network, access to the necessary medical community or in some cases the resources to these procedures. Their seemingly overwhelming medical problems will be taken in hand by a renowned team of medical specialists. The patients’ lives will be transformed before viewers’ eyes as the professionals employ cutting-edge medical technology to heal those who need it most. The team will not only restore the patients’ health, but their hope in living a whole life again.
We’re apparently now leaving the really sick and uninsured to reality television as their care takers, as opposed to creating a better medical system where all “ordinary people” have “access to the necessary medical community or in some cases the resources to these procedures.” So, dying people without health insurance, I recommend either the really sad, depressing story, or perhaps the cute children perspective so that Miracle Worker’s producers will choose your loved one to live, while another’s loved one dies. If the producers are somehow able to figure out which patients “need it [healthcare] most,” I’d love to hear their algorithm.
I saw a commercial for the show last night, and I couldn’t be more frustrated with the portrayl of the physicians on the show. Physicians are not miracle workers. (I’ll include myself in the ‘we’ here, even though I’ve got a little over a year before I’m a doctor myself.) We’re not gods, as a patient’s mother told me and my attending last night. Physicians, contrary to popular belief, are humans. Falliable humans. We’ve devoted much of our lives to caring for patients, by means of understanding the intricacies of the human body, how it works in health, and how it dysfunctions in disease. This is the distinction. Gods and miracle workers snap their fingers, or wiggle their noses (wait, that’s witches) or do whatever they do and make effect without any prior cause. Physicians figure out what the disease is, so they can understand its cause, so they can change something to alter the effect. They’re two entirely different branches of healing. The former is perfect, effortless, and instantaneous. The latter requires training, experience, and knowledge and is definitively human. That’s human all senses of the word, including “imperfect.”
Part of the reason I make such a distinction is because of the assumptions patients make about physicians, based on their understanding of how physicians work. After being told that physicians are “like gods,” my attending responded that “We’re no more like gods than any other person,” which was the perfect response. When patients assume physicians are perfect, or god-like, or saints, or miracle workers, they start having irrational expectations. When an error occurs, or a proper diagnosis isn’t made, it’s often hoped (and also assumed) that everything will go perfectly–that the error rate is 0% and the success rate is 100%. And that’s simply not the world of medicine that exists.
Physicians are taught to understand everything–I mean everything–as risk versus benefit. There are risks to giving a patient oxygen. There are risks to giving a patient some IV fluids–or even just giving a patient a meal or water. And physicians only do any of these things if they feel that the benefits outweigh the risks. This is what’s meant by “first, do no harm.”
I’ll repeat it: physicians are no more like gods than any other person. Yes, we had quickly figured out that the mother’s child had a malrotation that required urgent surgery, and that surgery was performed, and her child’s life was saved. But it was because the mother realized the child’s vomitting was of concern and brought the child to the hospital. And it was because the resident who saw the child recognized the child’s age and symptoms and made the diagnosis. And it was because the surgeon was able to repair the malrotation. And it was because the anesthesiologist properly monitored the child’s vital signs, and because the nurses caring for the child watched him closely, and because the respiratory therapist helped maintain his lung function. There was no snapping of fingers, no wiggling of noses.
Often, miracles seem like miracles because some of the treatments physicians give can rapidly take someone from dying to not-dying over the course of hours or even minutes. There’s a certain condition in the elderly that often causes them to have episodes of losing their vision–and if steroids are given, miraculously their vision can be spared. But it’s because the physician recognized the condition, understood why it occurs, and then understood the way to stop it from occuring.
And miracles? They’re statistical outliers. They’re luck. Listen: if my loved ones were sick in the hospital, I’d be praying as hard as the next man–but I’d realize the odds. The miracle involves being the one out of ten thousand that survives a disease. That’s just damn luck.