Intended for healthcare professionals

Sacred Cows

Sacred cows: to the abattoir!

BMJ 1998; 317 doi: (Published 19 December 1998) Cite this as: BMJ 1998;317:1729
  1. W G Pickering, general practitioner
  1. Newcastle upon Tyne NE3 4AL

    Medical omniscience

    The incalculable number of medical problems and questions to which the medical profession has no certain answer is balanced by the incalculable number of times that its members none the less provide one. Many patients, not unnaturally, want definitive answers on diagnosis, prognosis, and side effects. When doctors are uncertain or do not know, they think that the patient should believe otherwise. An answer, any answer, it is felt, assuages the patient's fear and anxiety, as well as confirming a doctor's omniscience. Abating a patient's anxiety indubitably promotes their health, but what if the answers given are wrong?

    Doctors can be comparatively certain about some matters—for example, uncomplicated appendicectomy or antibiotics for impetigo. They can give an educated guess about some others—for example, Bell's palsy, treated asthma—and have little idea about others—for example, the outcome of some major operations, the value of antidepressants, the side effects of many drugs. That they sometimes dissemble with their confident answers is an involuntary habit that can be medically dangerous, …

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