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Medicine is becoming more evidence based. Our ability to collate vast amounts of information has been enhanced by computers. In an ideal world no investigation or treatment would be offered to a patient until all possible research had been completed. Sadly such a state of utopia is not possible. I sometimes say to my juniors that no operation should be performed by a surgeon who has performed that procedure less than one hundred times. Of course, when surgeons are training there must be a senior with them to guide them.
Every time there is a new development, we subsequently learn of possible risks. It was only shortly after the second world war that antibiotic treatment for tuberculosis (TB) became feasible. Until that time TB was one of the more common causes of premature death. The mother of one of my friends was one of those first treated with streptomycin. The TB was cured but sadly the streptomycin resulted in her becoming deaf. Whilst an advance in medicine had saved her life, she never really forgave her doctors for the deafness which was particularly tragic as her daughter became a talented singer.
A recent radio advertisement for vacations in the West Indies starts by saying
'Tomorrow the weather will be hot. Next week rain ------- is unlikely.' To those of us living in Northwest Europe the weather is so unpredictable that it is a common starting point of conversation. Medicine is far more like the weather in Northwest Europe than in the West Indies: weather forecasting is not an exact science even for predicting the next 24 hours. A colleague of mine recently returned with his family from vacation in the West Indies. Shortly after the plane started back across the Atlantic, it was unexpectedly attacked by a severe storm and everyone on the plane, including the staff were pleasantly surprised that they made it back. Doctors can advise from the best currently available information but we are not prophets who can accurately predict future developments.
Every aspect of medicine is under evaluation, re-evaluation and debate. Some patients may find this confusing. There is, however, variation of opinion in every profession whether it be in the domain of politics, science, education, art or religion. There is always need to evaluate the information and make an informed choice. Whenever there is good evidence, medicine should be based on it. Medicine, however, must strive to find a balance between utilisation of the latest advances and the current tried-and-tested investigations and treatment.
   
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