12/5/06

Imperfection and medicine
Or: You don't look well.

Here's a suggestion about one thing that makes being a doctor different from other professions, like playing the flute, writing poetry, or studying rattlesnakes. Each of these is concerned with the attainment of a perfect expertise -- or, at least, it's commonly thought by the practitioners themselves that there is such a thing as the most expressive flute player, the greatest poet, the most knowledgeable and groundbreaking herpetologist. Certainly it's true that one doctor can be better than another, but the trick is to define the right criteria. I'm not sure that doctors think that Jones, say, is a better doctor than Smith because she cures more of her sick patients than Smith does -- outcomes research notwithstanding. Because even if Jones cures all of her patients in one heady day of clinic, there are those of them who will get sick again -- some of them incurably. Some others will die. Some, to be sure, will get better again, through Jones's talents or in spite of them. But -- and this is what might distinguish doctoring from philosophizing or flute-playing -- much of Jones's professional life will be spent not attaining or even working towards perfection. Health is a doctor's goal, but only in a first-order sense. Most of the doctor's time is spent helping his patients deal with sickness. It would be strange to call the pianist an expert in missed notes, or the poet a coiner of slightly inapposite phrases, though such is their lot. It is more fitting to call the doctor a navigator of illness. If there's an aesthetic in the doctor's art, it's a negative one.

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