A cogent, forward-looking piece that highlights some of the most salient themes overarching the field of Medicine.
Title: The Laws of Medicine: Field Notes from an Uncertain Science
Author: Siddhartha Mukherjee
Genre: Nonfiction
Originally published: 8 October 2015
Finished reading: 15 August 2019
Links: Get this book on Amazon
Do not be put off by the title. It is not a didactic, academic-paper-style book—far from it.
Through anecdotes and allusions to historical experiments and medical cases, Mukherjee artfully derives three ‘laws’ that govern the field of Medicine. Unlike his Pulitzer Prize-winning The Emperor of All Maladies, you can easily finish this short volume in just one sitting.
LAW ONE: A strong intuition is much more powerful than a weak test.
LAW TWO: “Normals” teach us rules; “outliers” teach us laws.
LAW THREE: For every perfect medical experiment, there is a perfect human bias.
Even though I had not yet commenced any form of medical training, I found myself identifying deeply with Mukherjee’s propositions. They will likely take on even more profound meaning when coupled with personal experience.
On the whole, The Laws of Medicine showed me the dynamism, fluidity and uncertainty of Medicine as a discipline. Not only is Medicine ever-evolving with the latest advances and therefore never static over time, there are and always will be outliers and anomalies that cannot be easily characterised nor categorised.
The complexity of the human body and the sophisticated workings of the various biological systems that govern it insinuate that when part of such an intricate system is rendered dysfunctional, the consequences can be multifarious—and the underlying cause, at times, elusive.
Mukherjee’s cogitations on the nature of Medicine reflect substantial clinical experience and professional expertise. Yet they also reveal his propensity for deeper thought and reflection. Such rumination transformed into succinct prose arguably transcends the study of science and is steeped deep in the realm of the humanities.
This is not to say that Medicine is not based on the strong foundations of science. But pure, hard science alone would not have led Mukherjee to ponder, to question, to experience and to synthesise. It would have been woefully inadequate; it would never have culminated in this book.
Reading it was for me a potent reminder that Medicine is a fundamentally human endeavour. In Medicine, the human element is indispensable—perhaps even core to this ‘science’. For ultimately, doctors are treating patients—people—striving to alleviate their suffering and enabling wellbeing. As Mukherjee concludes,
The “youngest science” is also the most human science. It might well be the most beautiful and fragile thing that we do.
This thought-provoking book is a must-read for both current and prospective medical students.
My favourite quotes from this book
(All quotes are arranged in chronological order as they appear in the book, with the chapters indicated in parentheses.)
“It’s easy to make perfect decisions with perfect information. Medicine asks you to make perfect decisions with imperfect information.”
― Siddhartha Mukherjee, The Laws of Medicine: Field Notes from an Uncertain Science (Author’s Note)
I had never expected medicine to be such a lawless, uncertain world. I wondered if the compulsive naming of parts, diseases, and chemical reactions — frenulum, otitis, glycolysis — was a mechanism invented by doctors to defend themselves against a largely unknowable sphere of knowledge. The profusion of facts obscured a deeper and more significant problem: the reconciliation between knowledge (certain, fixed, perfect, concrete) and clinical wisdom (uncertain, fluid, imperfect, abstract).
― Siddhartha Mukherjee, The Laws of Medicine: Field Notes from an Uncertain Science (Author’s Note)
If medicine is a science at all, it is a much softer science. There is gravity in medicine, although it cannot be captured by Newton’s equations. There is a half-life of grief, even if there is no instrument designed to measure it. The laws of medicine would not be described through equations, constants, or numbers.
― Siddhartha Mukherjee, The Laws of Medicine: Field Notes from an Uncertain Science (Author’s Note)
Medicine is in the midst of a vast reorganization of fundamental principles. Most of our models of illness are hybrid models; past knowledge is mishmashed with present knowledge. These hybrid models produce the illusion of a systematic understanding of a disease—but the understanding is, in fact, incomplete. Everything seems to work spectacularly, until one planet begins to move backward on the horizon. We have invented many rules to understand normalcy—but we still lack a deeper, more unified understanding of physiology and pathology.
― Siddhartha Mukherjee, The Laws of Medicine: Field Notes from an Uncertain Science (Law Two)
[H]uman decision making, and, particularly, decision making in the face of uncertain, inaccurate, and imperfect information, remains absolutely vital to the life of medicine. There is no way around it. “The [political] revolution will not be tweeted,” wrote Malcolm Gladwell. Well, the medical revolution will not be algorithmized.
― Siddhartha Mukherjee, The Laws of Medicine: Field Notes from an Uncertain Science (Law Three)
The “youngest science” is also the most human science. It might well be the most beautiful and fragile thing that we do.
― Siddhartha Mukherjee, The Laws of Medicine: Field Notes from an Uncertain Science (Law Three)