The seven sins of medicine

Below is a story I read in the New England Journal of Medicine as an illustration of the seven sins of medicine. The seven sins were put forth by Dr. Richard Asher in 1949. Asher, a Brit, was regarded as "one of the foremost medical thinkers of our times" who emphasized the need "to be increasingly critical of our own and other people's thinking.” His list of the seven sins of medicine is still relevant today.

Here’s the story: A guy has a dizzy spell. He goes to the emergency room, which, it turns out, is just the beginning of his medical misadventures which included the following: electrocardiogram, blood tests, x-rays, CTs of his head and neck, an MRI of his brain, treadmill stress test, “pharmacologic stress test,” two angiograms, ultrasound, audiogram, and, finally, a recommendation that he see a neurologist “because I can’t rule out a problem with your central nervous system.” At that point, the guy stops with the tests and goes with the suggestion of his niece, a young internist who has told him that he has BPPV (benign paroxysmal positional vertigo), a common condition that I and many of the people I know have experienced.

The seven sins are the following: 

1. Obscurity. "If you don't know, don't admit it. Instead, try to confuse your listeners."
2. Cruelty. Not following the Golden Rule.
3. Bad manners. Being rude.
4. Over specialization. Undervaluing generalists.
5. Love of the rare. In hearing hoofbeats, thinking zebras instead of horses.
6. Common stupidity. The opposite of common sense.
7. Sloth. For example, ordering excessive tests instead of taking the time to take an adequate history.

The guy in the story is particularly furious at what he calls “mental laziness.” “Where’s the science?” he says. “I’ve got this fleck of calcium tumbling around in my inner ear, and they tell me maybe it’s a heart attack!” The bills for all of this amounted to $74,542.

In researching Richard Asher, I was flabbergasted to learn that we knew his son Peter, a music producer. Peter lived down the street from us in Los Angeles. Our son, Rob, recently met up with Peter in Manhattan.

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.