Eliminating Medical Error through Science, Intelligence, & Hard Work

     Some mistakenly believe that all ignorance can and will eventually be eliminated through science, if only we work hard enough, intelligently enough. But no amount of workaholic zeal can reach this utopian goal, because it's based on a fundamentally flawed worldview.

     "The belief that every error is correctable, either now or with the benefit of future knowledge, requires the nature of reality to be organized in a certain way, a way that allows events and actions to be isolated and purified and mapped precisely onto a set of formal descriptions. In short, reality must be discrete and atomistic for this to occur, and discreteness of this sort is antithetical to holism. ... medicine’s necessary focus on individuals that are unique and dynamic introduces an unavoidable shortfall between scientific knowledge of the general and universal, and the application of that knowledge to understanding particular things. ... using the well-known shortcomings of weather forecasting as an example, ‘perfect knowledge of that one particular hurricane is unavailable except under conditions of omniscience.’

     A review of the literature on medical error ... notes that practising doctors are aware of a ‘necessary fallibility’, which forms part of their understanding of error. However, this seems to be cashed out in terms of ‘permanent uncertainty’, which suggests that rather than a metaphysical picture of the world being in a certain way, it is an epistemic picture of imperfect scientific knowledge, or even sheer randomness. This view encourages a fatalism and shared vulnerability about the potential for error ... What it might fail to do is to inform a coherent understanding, which can be directed towards reducing error."
        Wilson B. Metaphysics and medical education: taking holism seriously. J Eval Clin Pract 2013; 19(3): 478-84.

     Neither fanatical scientism, nor fatalism / nihilism are reasonable. Reality is somewhere in between these extremes. A good clinician engages her whole being to help her patients the best ways possible. ALL patients, as well as clinicians, will die anyway. AND, unless locked into some rigid, erroneous, limiting worldview, we can all evolve as human beings and live a wonderfully satisfying life.

Ireland