A Type 4 Turd.

by reestheskin on 24/05/2015

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Reviewed in the NYT, a quote I should never have forgotten. The book, ‘Do No Harm’, by Henry Marsh, remains the book all medical students should read. (And I will only say that once every five years).

Clinical practice is becoming a theater of the absurd for patients as well. Hospital charts are filled with N.H.S. forms detailing irrelevant aspects of care. Searching for a patient’s operative note, Marsh finds documentation she passed a “Type 4 turd.” He shows her an elaborate stool chart “colored a somber and appropriate brown, each sheet with a graphically illustrated guide to the seven different types of turd. . . . She looked at the document with disbelief and burst out laughing.”

And as to what medicine is:

He dismisses the popular notion that surgery is a mix of art and science. “I have always found this rather pretentious, and prefer to see what I do as a practical craft. Clipping aneurysms is a skill, and one that takes years to learn.” This is the journeyman nature of operating, an iterative process that ultimately results in earned expertise

Well, for me the crisis in modern medicine is to do with this very topic: expertise and how well distributed it is in professional practice. To paraphrase Keynes wanting economists to be as useful as dentists, I too wish doctors were always as expert as the travelling  journeyman. Too much reflection, and lofty verbiage, serves us—and out patients— ill.

[direct link to this aside]