Mantra

Medicine is not only about science, it's sometimes about dogmas handed down from generation to generation. Sometimes, these universally accepted dogmas are more often wrong than right.

That's what I taught the two medical students joining me last week for apprenticeship program. The greater the ignorance, to paraphrase Sir William Osler, the greater the dogmatism.

Our conversation started when a senior consultant taught us the rules and dogmas of using diuretic in patients who have weakening of the heart's pumping capabilities. Seemingly, we're inculcated to use continuous infusion of diuretic in case of acute heart failure. I listened and was tempted to say that it doesn't really matter with either intermittent boluses of diuretic (one dose at a time) or continuous infusion. But, of course, I didn't say it openly. Instead I passed my phone sheepishly to my students after opening a page of the New England Journal of Medicine to prove my point. They nodded.

Few days later, we brought a patient to have emergency endoscopy at night because he was bleeding from an ulcer in the stomach. Our conversation, again, was about how to give the stomach remedy called proton pump inhibitor. I pointed to studies that said giving the drug as intermittent bolus is as good as continuous infusion. Hold on, I reminded my students, to take a look at what the doctors did in reality.

The truth is, our patient was receiving continuous infusion of proton pump inhibitor, a practice that is more expensive and inconvenient - but simply in accordance to the dogma.