May

Medical evidence has a credibility problem that is rooted in the fundamental problems with statistics. This problem is manifest in the inability to reproduce evidence on repeated randomized clinical trials (RCTs). Theoretically, an RCT is the way to answer questions about which treatments are useful, but practically, an RCT is too expensive to conduct with enough patients to get answers to such questions.

Maybe it’s the acoustic cover of “Despacito” playing the background. Maybe it’s the late-night cuddles I received before opening my laptop. Maybe it’s the solemn knowledge that this is likely the last thing I will write in the BCMJ as your president. Whatever the cause, I am in a reflective mood as I consider everything that we have accomplished together this year.

This is a fragile, uneasy time. Unstable markets, privacy breaches, and politicians who treat nuclear codes and human rights like the plot lines of a reality TV show have all created a collective unease. In health care, we’re seeing soaring costs due to bureaucracy, increased needs, and innovations in investigation and treatment. What resources we do have are further stretched by preventable outbreaks of disease due to vaccine misinformation, the replacement of nutrition by a supplement industry worth billions,[1] and mistrust in medication due to Big Pharma scandals.[2]

Observing the current federal and provincial political scenes makes one wonder why anyone would become a politician. The same question may be more valid when considering medical politics which, as Dr Pat McGeer implies, is more demanding and less well paid than the real thing.[1] Many of us have tried, without achieving the level of satisfactory outcomes that we hoped for.

I often log on to my EMR remotely to check results on days I’m not in the office. At one point, I saw a patient in the office and diagnosed him with a minor illness requiring no treatment. Later, I checked my EMR and there in front of me was the sickening truth that I had made a mistake. He had presented to emergency the night before with a life-threatening illness. Much to my relief the patient didn’t die, but he could have. I immediately felt guilt, remorse, shame, and self-doubt accompanied by a chest pain and a sinking feeling in my abdomen. I was flooded with negativity.