On medical


One day when I was a junior medical student, a very important Boston surgeon visited the school and delivered a great treatise on a large number of patients who had undergone successful operations for vascular reconstruction.

At the end of the lecture, a young student at the back of the room timidly asked, “Do you have any controls?” Well, the great surgeon drew himself up to his full height, hit the desk, and said, “Do you mean did I not operate on half the patients?” The hall grew very quiet then. The voice at the back of the room very hesitantly replied, “Yes, that’s what I had in mind.” Then the visitor’s fist really came down as he thundered, “Of course not. That would have doomed half of them to their death.”

God, it was quiet then, and one could scarcely hear the small voice ask, “Which half?”

15 thoughts on “On medical”

  1. Surgeons seem to think of some new idea and then give it a try. If it works, it spreads to other surgeons and at some point somebody might write it up.

    There is a complete difference in philosophy. My hunch is that the progress of surgical techniques is faster as a consequence. Undoubtedly mistakes are made along the way as a consequence.

    Lots of surgical techniques make their way from veterinary science to human medicine, too. In that case, there probably are controls.

    Surgeons are practically a different species from physicians though I think.

  2. Michael Jennings, the problem is, that if surgeons don’t do controlled studies, we don’t know how they are progressing, so we can’t say if they’re making faster progress. There’s been studies of how effective surgery is, compared with placebo surgery. Sometimes it is n’t.
    See for example http://www.skepdic.com/placebo.html

  3. Tracy: I’m not really questioning that, just commenting on the difference between the two. To me, one side appears to be leaning too much one way, the other too much the other way.

  4. At least the medics are mostly making up for 2,000 years of obscurantism with some science. But TW links (2 links) to a govt handout, with a double blind trial. Some get the sub, some don’t, at random. The lefties are up in arms about it. If you can’t do a test to see if handouts work? Ye Gods.

  5. Surgeons also have (and probably need) enormous self-confidence. The claim is that if you are cutting into somebody’s heart or brain, doubt can be as dangerous as ignorance or error.

    No doubt it also has negative impacts. Whether these are outweighed by the operational (yes, ha ha) benefits, I’m not sure.

  6. Do you really need double blind trials on surgery as most of it is just an enhancement of an earlier technique?

    For example key hole surgery to remove the gall ladder was a great advance, saving time and money and with a speedier recovery, but didn’t need a double blind trial (if that had been possible) to see how effective it would be.

  7. Yes, you bloody well did. A statistical analysis, anyway. We now know that when it goes right, minimally-invasive surgery leads to speedier patient recovery etc., but we also know that if the surgeon is a butter-fingers it’s more dangerous than hacking a ruddy great hole in someone. It was precisely the result of looking at patient care outcomes in a statistical fashion that led to the current best practise training regimen that potential laparoscopic surgeons have to undergo.

  8. But that’s not a double blind trial as applied to new drugs, just a standard cost benefit analysis and review of staff competence.

  9. How would you do a double blind trial on butter fingers?
    Or young surgeons or tired surgeons or left handed surgeons etc.

  10. So Much For Subtlety

    You don’t have to do a double blind trial. You ought to be able to compare success rates to those of existing treatments.

    Likewise, a basic statistical analysis should show which doctors are incompetent. Or murderous. After Shipman people wanted to know why his unusual pattern of patient outcomes was not spotted by a NHS computer.

  11. @SMFS – Shipman was spotted by humans though. The only problem was that other humans didn’t listen and do something because they were more interested in covering their arses and passing the buck.

  12. It is quite possible that the mst efficient surgeon was those that did a lot of unnessary operations.
    There was a time in Australia when most adults seemed to have no appendix , tonsils or teeth.

  13. There are numerous paradoxes and un-intuitive results in this sort of thing. For instance, the very best surgeons might have high rates of patients dying on the operating table because only the very best will even attempt certain dangerous procedures such as separating siamese twins.

    I recall trying to explain to someone on this blog during the last US presidential election campaign that, for similar reasons, the fact that McCain had crashed two planes or something as a naval carrier pilot did not necessarily mean he was a worse aviator than a commercial pilot who had never had a crash.

  14. On a lighter note… An earlier Prof of General Surgery at Guy’s once commented that “many surgeons have the same psychological profile as criminal psychopaths and only wear gloves in order to not leave fingerprints”. 🙂

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