Blind Spots: a book review about healthcare quality

The past 100 years of medicine has seen incredible intellectual and technological advances that have resulted in a major improvement in morbidity and mortality for people around the world.  Our understanding of molecular, genetic, and cellular functioning have revolutionized our understanding of disease and pharmacotherapy.  Surgical techniques have evolved from barbaric and painful operations to minimally invasive, precision guided procedures.  Even the healthcare system has advanced to the point that within minutes, trained medical personnel can be with an individual experiencing a time-sensitive, life threatening emergency providing live-saving interventions.

All of these advances are built on generations of physicians devoting themselves to the pursuit of truth as they try to answer questions about the hidden workings of the human body and find new and improved ways to mitigate human suffering.  Rigorous pursuit of science and the scientific method has led to the discovery of all that we now take for granted as normative in medicine today.

Not surprisingly, despite the great improvements that we see in health care, there have been a number of mistakes, detours and false narrative.  Though not unprecedented across fields of discovery, these errors of understanding and practice are the flip side of the discovery coin and the dark side of medicine.  For as many things we have gotten right, there are a number of things that we as doctors and scientists have gotten dreadfully wrong.

Our recollection does not need to be prompted very far in search of an example.  "Follow the science."  This was the mantra throughout the COVID pandemic supporting mainstream, medical recommendations with seemingly thin and controversial scientific support: wear a cloth mask, no, wear 2 cloth masks; stay 6 feet apart; don't spend holidays with your family; avoid congregating in public spaces - even outdoors.  All of these were touted as official medical recommendations during the COVID pandemic. 

A little grace does need to be extended as we judge the early responses.  At the time we were faced with a novel virus which dramatically took the lives of a large number of people – young and old.  However, as more became known,"Follow the science" became more of a political bludgeon rather than a quest for truth as those who dared to question the official medical establishment were labeled "Science deniers" and ostracized from the hallowed and sanctioned medical spaces.  The closing of scientific inquiry to dissenting views turn "Follow the science" into a exercise of anti-science group think.

True science is about discovering the natural world.  It is about making a hypothesis and testing the hypothesis.  It is about challenging what we know - not in some form of a post-modern deconstructionist exercise, but as a way of rooting out minimally supported and stale beliefs in the quest for what truly is.  It is about discovering truth!  Along the way we will discover inadequacies in our understanding and errors in our logic.  As a medical student, one of the deans of my medical school told us that half of what they were teaching would be shown to be wrong - they just didn't yet know which half.  The key is keeping an open mind.

Yet, that idea of exposing yourself to information that challenges the status quo is easier stated than implemented in practice.  Medical dogma is a fixture of healthcare that has plagued physicians for generations.  Every specialty is littered not just with examples of changes that have propelled that field forward but also, but deeply entrenched beliefs and practices based more out of tradition than evidence.  Medical dogma has its roots deep in human psychology exposing how we make and hold beliefs and how those beliefs are impacted by the group think around us.

In this book, Dr. Marty Makary explores the idea that there are may ways that medicine over the years has gotten things wrong.  Whether through group think or tradition he discusses various different firmly held beliefs in recent history of medical care and shows how the data does not support status quo practices.  He concludes by listing a number of current controversies in medicine and encourages scientists and physicians to challenge entrenched narratives in search of the truth.

Studies show that health care professionals are generally a revered and trusted class of individuals.  Yes, there will always be medical skeptics who will not believe anything said by a doctor because it contradicts some deeply held belief or internet opinion.  But in general, we  as physicians have been entrusted by the public with a great deal of trust.  And for those of us who are physicians, this is one of the most important things that we need to guard and protect.

Exposing our areas of failure can be a challenge - full of concern about the effect it will have on public perception and trust.  Dr. Makary writes not to denigrate medicine or degrade the esteemed perception of physicians in the eyes of the public.  Rather, he writes as a way of exposing the areas where we as physicians have become blinded by tradition and group think.  He calls us to ask the hard questions, examine the evidence, and take a fresh approach in our quest to know truth.