Am I just a number?

Issue: BCMJ, Vol. 50, No. 9, November 2008, page(s) 538 Back Page
Gerry Greenstone, MD

Mired in all the statistics that are supposed to make patient care more scientific, a family doc wonders about the significance of his daily practice.

I have been a physician for over 35 years. I have seen the good and the bad, the success and the failures. I have made hundreds of phone calls, written thousands of prescriptions, experienced tens of thousands of pa­tient encounters. And then one day in the middle of a stressful afternoon—after yet another encounter, yet another prescription—I suddenly asked myself: Do I really matter? Am I making a difference?

So I attended a UBC conference about therapeutic outcomes where the lecture is supported by statistics and buttressed by science. I heard about N numbers and P values, about odds ratios and confidence intervals.

And through a maze of numbers and graphs I felt myself getting smaller and smaller until I reached the smallest number of all, the absolute risk reduction: the absolute difference in outcome rates between the control group and the treatment group. They told me it was usually about 2% to 3% depending upon the condition, sometimes more and sometimes less.
I sat there stunned and disheartened. I thought to myself: Is that the true meaning of my worth, the full scope of my skill—just 2% or 3%? Did that mean I had to treat about 40 patients just to benefit one?

But I also knew the numbers were not perfect; they had their own fallibility. They related to groups, not individuals. They informed me about 1000 patients but not about the one I saw at any particular time.

And I knew that with every interaction N equals one and only one. I went back to work the next day and continued talking and explaining, answering more phone calls and writing more prescriptions. But again came the nagging thoughts, the uneasy questions: Am I making a difference? Am I just a number?

Then in the course of a busy afternoon I had one of those clear moments, like watching a patient get better or receiving a rare compliment. And in that moment I felt a certain truth about my work.

I felt it from my patients: in the intense look of the eyes or the earnestness of the voice or the pressure of the handshake. In that moment I knew that after 35 years in medicine I was still accomplishing something, still making a difference. I am not a statistic. I am not a placebo. I am a family physician.

Dr Greenstone is a family physician in Surrey, BC