Mired in all the statistics that are supposed to make patient care more scientific, a family doc wonders about the significance of his daily practice.
I have been a physician for over 35 years. I have seen the good and the bad, the success and the failures. I have made hundreds of phone calls, written thousands of prescriptions, experienced tens of thousands of patient encounters. And then one day in the middle of a stressful afternoon—after yet another encounter, yet another prescription—I suddenly asked myself: Do I really matter? Am I making a difference?
So I attended a UBC conference about therapeutic outcomes where the lecture is supported by statistics and buttressed by science. I heard about N numbers and P values, about odds ratios and confidence intervals.
And through a maze of numbers and graphs I felt myself getting smaller and smaller until I reached the smallest number of all, the absolute risk reduction: the absolute difference in outcome rates between the control group and the treatment group. They told me it was usually about 2% to 3% depending upon the condition, sometimes more and sometimes less.
I sat there stunned and disheartened. I thought to myself: Is that the true meaning of my worth, the full scope of my skill—just 2% or 3%? Did that mean I had to treat about 40 patients just to benefit one?
But I also knew the numbers were not perfect; they had their own fallibility. They related to groups, not individuals. They informed me about 1000 patients but not about the one I saw at any particular time.
And I knew that with every interaction N equals one and only one. I went back to work the next day and continued talking and explaining, answering more phone calls and writing more prescriptions. But again came the nagging thoughts, the uneasy questions: Am I making a difference? Am I just a number?
Then in the course of a busy afternoon I had one of those clear moments, like watching a patient get better or receiving a rare compliment. And in that moment I felt a certain truth about my work.
I felt it from my patients: in the intense look of the eyes or the earnestness of the voice or the pressure of the handshake. In that moment I knew that after 35 years in medicine I was still accomplishing something, still making a difference. I am not a statistic. I am not a placebo. I am a family physician.
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Dr Greenstone is a family physician in Surrey, BC
Links
[1] https://bcmj.org/cover/november-2008
[2] https://bcmj.org/author/gerry-greenstone-md
[3] https://bcmj.org/node/2820
[4] https://bcmj.org/sites/default/files/BCMJ_50Vol9_back-page.pdf
[5] https://bcmj.org/print/back-page/am-i-just-number
[6] https://bcmj.org/printmail/back-page/am-i-just-number
[7] http://www.facebook.com/share.php?u=https://bcmj.org/print/back-page/am-i-just-number&via=BCMedicalJrnl&tw_p=tweetbutton
[8] https://twitter.com/intent/tweet?text=Am I just a number?&url=https://bcmj.org/print/back-page/am-i-just-number&via=BCMedicalJrnl&tw_p=tweetbutton&via=BCMedicalJrnl&tw_p=tweetbutton
[9] https://bcmj.org/javascript%3A%3B
[10] https://bcmj.org/modal_forms/nojs/webform/176
[11] https://bcmj.org/%3Finline%3Dtrue%23citationpop