Superstition in Medicine
“Hey Dr. Otte, tonight has been very q—–”
“Do NOT SAY THE ‘Q’ word! In fact, don’t even say the letter ‘Q'” “Oh shit, I said it! I said ‘Q’! Oh heckkkkkk!”
. . .
In my encounters in medicine, though there are a few devoutly religious practitioners, I have discovered that most of my young colleagues are not much into god(s). We are trained in, if nothing else, critical thinking. Without it, you can’t be a good doctor, and with it, it is profoundly more challenging to be a member of an organized religion or even to be spiritual. Though I respect and embrace the beliefs of others (and sometimes wish I could jump in their bandwagons, and have tried), I am not particularly in tune with any deities or superior moral imperatives. I am a humanist, ruled by science, in awe of the beauty of this world and the human capacity to construct and destruct. Science is my life. But somehow, something else creeps in.
Many doctors are high-strung and even have a tendency to have the Obsessive-Compulsive Personality Disorder trait (this is quite different from Obsessive-Compulsive Disorder). It seems to make us vulnerable to wanting to do everything possible (bizarre as it may be), with zeal, in order to do the best we can for our patients. As much as it goes against every fibre of my rational mind, I – and many of my similarly non-theistic comrades – hold bizarre beliefs. Superstitions are arguably the foundation of a lot of things we used to do in medicine. Sometimes the origins of these behaviours are simple cases of spotting patterns. Doing X seems to usually result in bad outcome Y, so never do X! We may not understand exactly why these things are correlated, but eventually science may catch up and explain why it’s X relates to Y as it does.
Sometimes these correlations are legitimate. The cover-all treatment of bloodletting has all but disappeared but we’ve finally figured out how it works, in the rare cases where it is appropriate to invoke. In Honduras, there are some icky ways to get the placenta out of a woman after delivery; having one’s face smothered with a farmer’s hat and drinking urine hardly seems like a good idea, but it might actually may make sense. In North America, some doctors maintain that redheads bleed more; this is something that has presumably been noticed in practice, and studies that explore the validity of this are starting to emerge. Do they bruise more because of some genetic bleeding tendency that we can’t yet identify? Or do they just notice bruises more easily because red-heads tend to have paler skin?
It’s not just medical conditions that doctors have funny ideas about. Life overall is influenced by these tough-to-justify thoughts. “We’ll just cross our fingers” is an expression used often, and when I utter it, it makes me sound like a quack, I’m sure. However, my intended meaning is “I hope that your particular concern results in something amongst the favourable outcomes, knowing the system involves a non-zero/non-unary probability.” Almost everyone I know has wished someone ‘good luck’ or ‘break a leg.’ Apparently, activating these good-luck superstitions actually improves performance. So, don’t stop! Keep your fingers crossed, and keep that lucky pair of socks or scrub cap handy.
Beyond luck, we often notice that all of the really bizarre patients show up at the hospital when there is a full moon. Not true – they’ve studied this! I know less about the Friday the 13th curse but it’s ever-feared, especially in the ER. Everyone knows, of course, that they come in 3s. Bad things, weird things, deaths, post-op complication patients, drug-seekers who’ve photocopied the prescription you wrote, etc. They even made a Grey’s Anatomy episode about it. Oh and Scrubs did a bit on it too:
It’s tough to draw the lines between idiosyncratic fears, common sense, and evidence-based practice sometimes. We do things for reasons we don’t always understand; sometimes it just seems like a good idea to wear a mask while doing surgery (no proven reduction in post-op wound infection rates but nice to prevent bodily stuff squirting in one’s mouth) or to clean the skin with alcohol before giving a needle (no proven reduction in needle-site infections). But our irrational beliefs can also have negative consequences; bizarre beliefs around transmission of HIV/AIDS, vaccines, etc. are very challenging for health-care workers in Africa. Some are calling for change.
Patients are a whole story unto themselves, but a few examples come to mind. Prenatal patients always have new and wonderful ways of predicting the gender of their unborn babe; the most common is that the heart rate of a baby will be high if a girl (140-160) and lower if a boy (120-140). I’ve met Chinese patients who didn’t want their surgery booked on a day with a 4 in it, or want to have their baby on a special day; on September 9th, 2009 I was asked by a non-yet-due woman for an induction to guarantee a lucky birth. In Ireland, the idea that moving on a Saturday is a bad idea, has greatly influence discharge planning; if you are discharged on that day, it won’t be long before you return to hospital, say the wee Irish and Scottish grannies.
It seems that all over the world, people think odd thoughts. It’s reassuring that I’m not the only weird one out there, but kind of disturbing that even the most science-minded aren’t immune to silly ideas. The true art of medicine is blending evidence-based practice with ‘common sense’ ideas and addressing the concerns – however unusual – a patient may have.
Remember now, an apple a day keeps the doctor away.