Courts Interpret Laws Differently – Even the Supreme Court, Depending on Individual Justices. Compare that with Interpreting Medical Science!

The arguments about nominating a new Supreme Court justice have illustrated how relative everything really is around here.

Since our Constitution is still being reinterpreted after all this time and since Roe v Wade may be reversed, depending on one 48-year-old woman’s opinion, is there any wonder why not all doctors think and act alike?

There may be laws of physics, although I don’t think all of them are immutable anymore, but there are hardly any laws in medicine. All we have to go on are data and differing interpretations of what to make of it.

It should be obvious that much of what we do in medicine is far from straightforward or universal. All we have are broad stroke images, rough ideas, of how our bodies and biomes work. Right now, as we struggle to understand how one virus differs from another, we look back and realize that some patients with Covid were dying because they were put on ventilators – and there we were, thinking we wouldn’t have enough of them.

Medicine is like a society without sophisticated laws; a culture, clan or cadre of practitioners with scientific training, intellectual curiosity and open-mindedness as well as a required amount of humility, because we are constantly navigating in uncharted and ever-changing waters. And this society is built on just a few principles, perhaps outlined best—but certainly not legislated—in the Hippocratic oath.

We face two obvious dangers: trusting our own knowledge too much and trusting conventional wisdom too blindly.

Most people think you need to be very smart and experienced to sit on the Supreme Court—or any other bench for that matter—even though the laws of the land may seem like they should be self-explanatory. Imagine how challenging it is to always be an effective physician. But is that how my profession is viewed right now?

No, we are portrayed as followers, rather than interpreters, of the science. But the truth is, we often face unique situations where there are neither laws nor good science to guide us.

And as the physicians treating our ailing president seem to be making unusual or even inexplicable treatment decisions, it should be obvious how inexact the art of treating individual patients really is.

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Osler said “Listen to your patient, he is telling you the diagnosis”. Duvefelt says “Listen to your patient, he is telling you what kind of doctor he needs you to be”.

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