Doctor, are you proud to be a doctor? And you, patient, do you still believe the doctor is the long-awaited saviour? I hesitated a lot before writing what you are about to read, because I am a doctor and because I write for a medical publication. Both oblige me to be loyal to my profession and to the place where I express my ideas, even if that means giving up objectivity and honesty. But I finally made up my mind to go ahead, hoping these won't be my last words.
There is no doubt that human medicine has long sat at the top of the sciences. It is still the first ambition of every top student and the favourite child of every university and scientific institution. In our countries this shows in the ever-rising grades needed to study it at state universities and the fees at private ones; elsewhere it shows in the huge sums spent on it and on everything connected with it, such as drugs and research.
There is also no doubt that a person who is ill still badly needs someone to give them a helping hand and bring back their hope and will to live. So it's no surprise that they see the person qualified to do this, in theory the doctor, as something of a rescuer and long-awaited saviour.
But does reality match these premises? In other words, after a long history of work and research, has medicine achieved what is expected of it, and how successful has it been? And has the patient become sure that the doctor really deserves to be called a saviour? To what degree?
To answer the first part, I'll say that medicine has achieved some success, so as not to deny it its due, and I'll estimate that success at 30%. This isn't an arbitrary figure: it comes from my attempt to put medicine's work so far into numbers. I divided that work into four main areas, estimated its success in each as a percentage and then combined them. The areas are: discovering diseases; identifying their causes; understanding how they develop; and finding a cure or complete prevention.
In the first area, discovering diseases, medicine has been largely successful, although we can't be sure we know every disease that can affect humans, as the future may bring more. We can put success here at 90%. In the second, identifying causes, we will be very disappointed, because we don't fully know the causes of most known diseases, except those caused by infectious agents. But infectious diseases make up only about 10% of human diseases, so we'll put success here at 10%. The third area, understanding how diseases develop, is also frustrating: we are still groping to understand most diseases, and nothing is easier than to find medical books saying "the aetiology is unknown". Success here certainly doesn't exceed 10%. As for the last area, a cure or complete prevention, there is plenty to say: there is no cure or complete prevention (I stress the words "cure" and "complete") except for infectious diseases, thanks to antibiotics and vaccines, and not for all infectious agents, of course. So again we put success at 10%. A simple sum gives an overall success rate of 120/400, or 30%.
To answer the second part, I'll simply translate this figure into reality and leave patients to judge how much they have been saved. 30% means that fewer than a third of patients will find a cure or complete prevention at the doctor's, mostly for one type of disease: infections. It also means that a patient will get a third of the treatment or prevention they need from the doctor, and that treatment will not cure but relieve, and the prevention will be partial, not complete.
Finally, I must point out that this shortfall is not the doctor's fault but medicine's. So, doctor, don't feel ashamed; and you, patient, don't feel resentful!
By Dr Ayham Ahmad
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