When Doctors Discard Sacred Oaths
What's the difference between matter and antimatter?
If you ask a physicist, they'll tell you that a particle and its antiparticle are exactly identical in every way, except for a few specific properties, where they're exactly identical in every way except for being oriented in the opposite direction. And if they ever come together, a violent explosion occurs.
This is the best paradigm I've found for understanding "anti-racism" and "anti-fascism."
Martin Makary, a professor of surgery at Johns Hopkins, estimated the number of deaths from medical errors at 250,000 annually in the USA. From 2000 to 2021, not counting the terrorism of 9/11, there were 19 deaths in commercial aviation. Since your doctor is vastly more likely to kill you than your airline pilot and since you have some choice about doctors but merely Hobson's choice about airline pilots, it makes sense to be much more selective about your doctor than your airline pilot.
Thanks for another thoughtful post. Leave it to the pragmatic, hands on wisdom of the nurse to have the answer! BTW, I don’t inquire about the pilot as I board an aircraft, but I often glance at the ID plate in the door to see how old the plane is...
"Trust can vanish in the same ways that money can."
But money is much easier to earn back. Trust, maybe never.
Thank you, Bob. One of the most cogent arguments for going against the current tide that I have read. And push back we must.
I think you've got it wrong. The reason we don't vet pilots is that pilot-induced death is extremely rare. Extremely. Just not worth worrying about. See how that works?
Given a patient's desire for comfort with a physician, it isn't surprising to find that patients may prefer physicians who share whatever identities (ethnic, political, religious, gender, whatever) the patient deems important. (Ask a male ob-gyn.) That doesn't change the physician's obligations but the patient has taken no such oath. This desire on the part of patients makes the issue of race in medicine more fraught than it might be in other fields. I don't have a good alternative. I'm just saying it's complicated.
I've long thought that there should be a policy of waiving all student fees (or debts) for those in medical fields who are living kidney donors. Aside from alleviating the dire shortage of kidneys, such a policy would give budding young doctors, nurses, etc., direct experience as hospital patients in an ideal situation where they're healthy.
“Because my life was in his/her hands...” Did you ever ask your students if they knew anything about the anesthesiologist who worked their surgery? Because talk about putting your life in someone else’s hands...
Asked to explain the differences between the surgeon and the pilot, the students—all medical professionals—struggled.
Med students? Hadn't they all passed through University courses in mathematics, as a condition of becoming med students? Were they so oblivious that they had never considered the very tiny probability that their single flight might crash, while millions of successful flights went well? The chance of disaster on a single flight is minute, and any person can take confidence that this one won't be different.
Now consider - where would you get a public record of probabilities of surgeries going wrong? It's not nearly as blatant of those plane flights. Those students who inquired about their individual surgeons were doing a very practical due diligence.
I've noticed that lots of people are in favor of racism and other forms of discrimination when they are or expect to be the ones who benefit and not be the ones hurt. Odd thing, that.
How about - if the surgeon screws up badly, they go home at the end of their shift.
The pilot has a much more vested interest in successfully landing the plane.
Now, operating on a mafia boss' favorite daughter - maybe that would be similar
Actually the best answer to the: "Why due diligence for the "Doctor" and not the "Pilot" question is this: "Because the Doctor knows that if he screws up his life is not at risk, but the pilot knows if he screws up we all go down together."
I can think of two additional reasons why the cases of commercial pilots and physicians are different, in addition to the interesting one you adduce:
1. Free riding. We usually travel not only with one pilot but simultaneously with a copilot, a bunch of flight attendants, and a few hundred other passengers, many of whom have flown far more than ourselves. The fact that several hundred *other* people, including many with way more relevant experience, are trusting the pilot with their lives at the same moment we are asked to do so, may ease our concerns, or at least diffuse our sense of responsibility. I think it's generally a phenomenon among humans that we feel less need to justify our trust when we're doing it as part of a big group.
But of course when you hire a surgeon, it's just you on whom he's operating (at least at that particular time). It would be interesting to ask people to compare choosing a surgeon with hiring a private pilot to, say, fly the family on a remote vacation -- a situation where you are *not* making a collective trust decision. It would also be interesting to ask whether rich people vet the pilots they hire for their private aircraft as thoroughly as they vet their surgeons*.
2. A greater certainty of the quality of outcome. The pilots' metric of success is nearly unambiguous: in almost all situations, if the pilot does his job right, the airplane lands successfully. There are still a few cases where mechanical or ATC failure dooms a commercial flight despite the best possible decisions by the pilot, but they're relatively rare these days -- and even then we can usually tell, after the fact, that something went wrong. It's pretty rare that a plan crashes (or disappears like MH 370) and we have no clue ever whether the pilot screwed up or the plane was doomed through no fault of his.
But by contrast, serious surgery is inherently quite dangerous, and people die all the time from it even if the surgeon and team does everything right. Furthermore, surgery, indeed medicine in general, is so complex and subtle an art that whether or not the physician is doing the right thing is something that is very difficult to objectively decide. The best minds can easily differ on whether this or that was the right choice, and even on whether a given decision led or contributed or had no effect on a bad outcome. Does this surgeon have more deaths because he's an idiot or because he takes tougher cases? Thus the enormous medical malpractice industry -- malpractice lawyers wouldn't earn nearly as much money if it was straightforward to know whether a given physician in given circumstances screwed up or not. Which means the question of physicial skill seems inherently harder to answer than pilot quality, which makes the question of trust more fraught. We probably vaguely feel like really bad pilots crash and get ejected from the career, but pretty bad surgeons can fly under the radar, so to speak, and last long enough to (gulp!) be operating on us.
* Indeed, the poorer we are, the more we perforce place our trust in institutions, because we just lack the resources to do the research needed to choose for our ourselves, and often have no real choice anyway. This points to yet another way in which those who want to inject racist ideology into medicine are committing evil: those who suffer the most from their distortions will be the poorest among us. We can be 100% sure that no matter how the institutions are distorted, Jeff Bezos will always hire the very best brain surgeon if his wife needs surgery. He will always have the resources to find and hire the best. So will all the rich people -- they don't *need* to trust that Harvard Medical produces first-rate physicians, or that board certification doesn't measure some skill in ideological bullshit instead of the scalpel, because they have the resources to vet the individual directly. It's those of us who can't afford to do so -- who lack connections, access, time and money -- who will suffer if the institutions are corrupted. And the poorest will suffer the most.
The pilot dies with the passenger. The surgeon doesn't. Skin in the game explains it all.
Once, the Hippocratic Oath meant something...over the last 50 years I have seen it largely ignored, derided, abandoned, and replaced by meaningless piles of unicorn feces...The primary motive for becoming a physician today is greed and proving yourself more 'woke' than your colleagues. Scientific articles in medicine are untrustworthy, and residents are more interested in time off than patient care...The entire profession, including nursing and paramedical professionals are more adept at nursing their computers than taking care of patients...sad, so sad...
The reason I don't need to check my pilot as I do my surgeon is that if the pilot messes up, they're going down with me and the plane. The surgeon, on the other hand, has malpractice insurance and will live to slice again...
Cheers, Jonathan Wight