Panta Rhei: Medicine 2.0

Radu Crișan-Dabija, Antigona Carmen Trofor


From ancient times, doctors have been seen as highly skilled and trained professionals, but the human nature of these professionals makes them susceptible to error. Nowadays, the rapid growth of information’s availability and the changes of guidelines are impossible to be followed by one specialist. Instead, medicine is transforming to a team -work effort to reduce the possibility of error and to deliver the most accurate results.


Medicine 2.0, medical error, diagnostic error, changes in medicine  

A pillar of philosophy attributed to the ancient scholar Heraclitus of Efes, the Latin expression “panta rhei – everything flows”, doesn’t just reaf-firm the fluids, obvious propriety but abstractly synthesizes the fact that, despite any intervention, from the inert matter into living things, everything transforms with the flow of time and does not return to the initial state. The society and the peo-ple forming it fit this ancient philosophical concept best. We actively participate (or just witness) to various transformations, each with unique impact and intensity, we discover and learn more and more, and we skill ourselves grinding the knowledge of our social experience gaining or dropping virtues and vices, living and transforming.

One cannot estimate the impact of being con-temporary with Plato, Pitagora or Hippocrates for a simple aspirant to mastery and knowledge, but being contemporary to Stephen Hawking, Gordon Moore or William Campbell, in the 21st century, means an immense exposure to the dissemination of research. A mean of almost 3000 articles is being sent to review each working day(1), leading to a hal-lucinating approximation of 1.346.000 (!!) of sci-entific work revised and published annually(2).

No matter what percent of this immense volume of publications is attributed to medical research, it is a certitude that a single professional, even an extremely capacitive one, cannot process, under-stand and apply knowledge from all the published resources.

A banal example seems eloquent: a scientific research update on asthma. Conducting a simple search, of all articles published and indexed by PubMed having “asthma news” as keywords, in 2016, the search engine returned already over 5000 articles(3) – a number impossible to go through by a professional needing to stay up-to-date on every thing relating asthma. Of course, channeling research and the possibility of filtering narrow the volume of information significantly, but the rhythm of updates and re-refreshment is so alert, that only experience, precise problematics, and affinity to a journal or an author or the affiliation of authors to an academic institution or research facility make a reader to choose discretionarily. And trying not to abandon the philosophical approach of the matter, dissecting more into this information one must ask if there is any sense in publishing research anymore, since there is no unanimous rule of filtration and the choice of a title is at the empirical or even emo-tional latitude of the reader. Adding to all this the fact that only a small part of research can be accessed free of charge, the paradoxical conclusion would be that, even there is an immense source of published research, a big part of it remains insuf-ficiently disseminated or accessed by the great mass of readers in the domain.

Still, these facts don’t always lead to correct con-clusions. Medicine does not belong to a single per-son anymore, to a single omniscient, all-knowing “orchestra-man” professional. I like to think that we have entered the era of Medicine 2.0, and the success of the therapeutic act belongs to a team sustained by knowledge and technology. All the medical knowledge, from the guidelines (updated more and more often) to the systematized research, does not fit into one physician’s mind anymore. This physician needs interdisciplinarity to assess the correct and complete diagnostic and to rapidly, efficiently and budget-cautiously treat a patient.

Not randomly we refer to financial efficiency. There is a growing idea of the healthcare systems’ shortfalls and deviations, the sub -financing being at the top of incriminated factors, mainly referring to the Romanian healthcare system. It is obvious

that at this point – in 2017 –it is absurd to compare ourselves with other countries’ healthcare achieve-ments, since the current poor state of our health-care facilities, the insufficient funding, and low salaries are no enigma. But the society is accus-tomed to amending the “whole” looking with super-ficiality at single cases, omitting the multitude of factors leading to the prosperity of Western European hospitals, the therapy abundance or com-plex paraclinical availability: private insurances, reporting the healthcare personal contribution to much higher incomes, different percentages of con-tribution and the “much-blamed” co-payment.

Far from advancing the comparison of health-care systems polemic, we must underline the fact that every country considers its healthcare system being imperfect because, as opposed to any other domain, it is absurd “ab originem” to monetize the human health, a fact perceived as unnatural from an instinctive point of view deeply carved into the human genetics. But society, upon its development, needs hierarchy and order to function, the same way as medicine needs guidelines and protocols to limit error. It is scientifically proven that doctors rely a lot on personal experience and heuristics, believing themselves immune to possible error sources in their diagnostic reasoning because of their highly-trained professionals’ statute(4).

Although modern imaging and diagnostic tools have evolved and should confer a safer and accurate diagnostic, it seems that the margin of error remained constantly unchanged throughout the time, and the pathology with a high risk of a wrong diagnostic remained the same. It is not about the rare conditions or complicated pathology that give doctors a hard time diagnosing, but the same old pulmonary embo-lism, myocardial infarction and pneumonia remain commonly the missed diagnostics(5-7).

In conclusion, everything flows. The medicine development achieved its point of cleavage between the infinite humanity of the medical act, financial efficiency, and scientific regulation. The medical error is today the sensible point, fairly and openly discussed. Divinity – the entity usually responsible with ease for all patients’ destinies – lost its per-ceptual influence and nowadays, the society holds the systems, the professionals and the procedures responsible for medical failures. The God’s will is no longer an invalidity or a death diagnostic, its place has been taken by the deficiencies in preven-tion, lack of adherence, cultural barriers, genetic predisposition etc., but also the medical error. However, a sense of mystery remains in the medical act, a certitude in “doctor’s flair” that makes prac-ticing medicine an art, susceptible to error but a magical act to protect healthcare and life. Everything flows and transforms because evolution makes us better, and the will to transform, just like Heraclitus of Efes’ philosophy, proves our doctors’ nature: to progress.

  1. National Institute of Health. MEDLINE/PubMed Update Chart for 2016: Summary of New and Revised Records. US National Library of Medicine. [Online] [Cited: August 7, 2016.] https://www.nlm.nih.gov/bsd/licensee/ table_sum.html
  2. Björk BC, Roos A and Lauri M. Scientific journal publishing: yearly volume and open access availability. Information Research, 2009, 14(1): 391.
  3. US National Library of Medicine. PubMed/Medline. [Online] National Institutes of Health. [Cited: 08 07, 2017.] http://goo.gl/yi4KiS
  4. Bornstein BH and Emler AC. Rationality in medical decision making: a review of the literature on doctors’ decision-making biases. J Eval Clin Pract, 2001, 7: 97-107.
  5. Kirch W and Schafii C. Misdiagnosis at a university hospital in 4 medical eras. Baltimore. Medicine, 1996: 7529-40.
  6. Zwaan, L. The critical step to reduce diagnostic errors in medicine: addressing the limitations of human information processing, Diagnosis, 2014, 1(1): 139-141.
  7. Schiff GD, Hassan O, Kim S, et al. Diagnostic error in medicine: analysis of 583 physician-reported errors. Arch Intern Med, 2009, 169: 1881–7.

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