"Medicine has two faces..."

"...the iodine-stained, glass-splintered messy reality we all work in, and the clean, quiet, dignified prose we use to record it." Dr. Abigail Zuger, MD, in the NYT:

"No absence of order penetrates our documents of record. The journals' glossy pages - or, now, neat online screens - are serene and pristine, rational and assured. Every study has a conclusion. Every case has a diagnosis. Every necessary test is performed, without fuss or muss.

"if there has been any drama finding a vein, or cajoling a claustrophobic patient into the M.R.I. scanner, or debating a practicing pagan who is refusing his blood tests because the moon is waxing gibbous, you certainly aren't going to read about it in the literature. Yet, it all happens, all of that and more..."

(I believe that's why most medbloggers blog!)

"...I figured that once training was over, life would become as orderly as it was in the journals. It was a delusion born of sleeplessness: medical reality always diverges wildly from the printed record. Drugs often don't behave the way they do in studies, and patients almost never do. Labs make mistakes. There is an unending parade of problems for which the received wisdom holds no answers...Why not tell it the way it is, for a change? Let journals immortalize all the messes and foul-ups in print, the spurious lab results, the problems that never get solved or the ones that seem to solve themselves despite us.

"Let's hear about the patients on the placebo, and the ones who drop out of studies, and the ones who can't get in to begin with. Let's see an article on infection illustrated not with nice boxed tables and graphs, but with pictures of, say, a wildly agitated, preternaturally strong patient burning with fever, drenched in iodine and blood, lurching off his rolling gurney and taking his doctors and nurses down with him."