Life

The Mistress of Medicine

Evidence-based medicine. I know, I know: It should be practiced like Tantric sex: effortlessly imparted, subconsciously spoken with each breath. I honestly am a fan of evidence-based medicine. I should stay faithful to it, because I know it is the true way forward, being so right, necessary and good.

And it is: Evidence-based medicine gets me off colluding that diabetes is caused by an imbalance in the flow of spleen energy and can be cured by perineal massage. It is what makes me confident that dull chest pain radiating to the left arm is not due to the overwhelming release of pent up negative emotions. I have a sound basis to dismiss the idea that infected eczema is due to a full moon in Uranus when staphylococcus aureus is more likely. However, embracing evidence-based medicine is also unfortunate, because evidence-based medicine is dull. It is boring and pedantic and way too academic for me. When I read the conclusions of reviews, they invariably conclude, after some unbelievably complex statistical analysis that: more work must be done. It all sounds like work, and work it is. Work to do, work to find, work to learn.

Anecdotal medicine is much kinder. It is easier to remember, being an evidence base containing, conviently enough, only what you can remember. Far from being an academic pursuit, jewels from the school of anecdotia are passed around for admiration around the metaphorical campfire, aural tales of ridiculously low sodiums, of unbelievably prolonged but successful cardiac arrests and strange, strange causes of anaemia. Anecdotal medicine tells us not just about patients but also about us: what we choose to remember, rather than forget. It has a mystical property. The sage looks not forward but backward through our careers so far. We remember who told what tales and when, stories from the edge of wherever we happened to be.

Anecdotal evidence is near the weird end of town. It is only slightly closer to your surgery than urban myth, and sometimes gets confused with it. It is a mythological beast. It grows in stature, and looks like we might be facing dragons when it was only a squashed slug at an odd magnified angle. Anecdotes are way down the route of personal experience, much more interesting than the roads that keep straight, narrow, and close to medical libraries. Roads intersect: stories are told. Vibrators are found in odd places, names are deleted, tales get taller, and anecdotal medicine lives on. Enduring long past the junction of gossip over coffee, anecdotes are more memorable than guidelines, more interesting than textbooks. Odd, bizarre, rare: something engages you, and becomes your own anecdote to tell. And maybe months, years later, you suddenly jolt with déjà vu: I have been here before...

I spent many months at the start of general practice afraid that I might be asked a difficult question. That was before I realised, one day, that I had been talking about methods of excess hair removal for ten minutes without drawing breath. The woman who had asked the innocent question was now plainly desperate to leave the room now that her doctor had turned evangelical. Had I been asked beforehand, I would have claimed I was in ignorance of the finer points and the latest research in this area.

But no. The question of whether this was an appropriate question for a doctor to answer did not enter my stream of consciousness. I did not recognise my voice at first, as it passionately outlined the problems of waxing, laser treatment and epilation. I seemed able to discuss (albeit with myself) whether shaving one’s legs really did make the regrowth thicker or not, based purely on stories I have heard. Bizarrely, the question of whether it would reduce overall pain to have both legs waxed simultaneously seemed natural to raise. This was based on the tale of two hairbunned ladies, with malevolent glints in their eyes and ruthless efficiency, who co-ordinated the ripping of hot wax off both legs, together with a thin layer of epidermis. At the time, it did not seem odd recalling the third degree burns a hair removal cream caused, on a man who thought he could skip shaving for a week if he left the cream on an hour longer than the pack advised. I seemed to know the relative discomfort of epilators, the best type of razors, and the length of time treatments lasted for.

I had discovered a rich seam of gems tossed to me by friends over the years and I was joyful in imparting it all. While it was a wonder to behold, it was also quite scary realising just how much trivia my mind has not only absorbed but is able to dutifully recall when tentatively asked. This has never worked for dry facts, medical exams or driving tests. This stuff was easy to remember. It was more interesting than Cochrane reviews or my methodologist husband’s MD. Your or your friends’ experience is so biased, erratic and haphazard that it should not shape your medical practice. But the stories that one hears are so fascinating and scandalous that it absolutely does.

So forgive me advising a very large gin before having one’s axilla waxed for the first time. For here you will go through the pain barrier and beyond, landing you right in that eerie place where medical knowledge counts for nothing. All the hours you thought you wasted, late at night, drinking coffee and telling tales were actually the most valuable ones you ever spent. Forget the subjugated long-term relationship with randomised controlled trials: anecdotes win: the mistress of medicine, supplying the thrills on the side, the kinky stories and the alluring prospect of more.