Overheard

This is from a department chair of medicine.

"Max Planck once said science advances one funeral at a time. With modern medicine, people are living longer and longer, and thus we are slowing the advancement of science."

I laughed at this joke. Max Planck, of course, was caught in the heyday of quantum mechanics, a scientific revolution of immense magnitude. This Kuhnian "paradigm shift" has always fascinated me, and indeed courses in philosophy of science focus entirely on this change in thought. The Old Guard - physicists trained in the early 19th century - were absolutely baffled by black body radiation and the photoelectric effect because it did not fit in their paradigm of thinking. Even when the emerging scientists - Planck, Einstein, de Broglie, Heisenberg, Born, and Dirac - began to create a new theory to accommodate these phenomena, the Old Guard put up resistance. How could there be non-Newtonian physics? It's simply inconceivable, they felt.

But science advances one funeral at a time. As the old physicists passed, these new, brash scientists came into prominence and as they gathered momentum, they effected what Kuhn calls in The Structure of Scientific Revolutions a paradigm shift. Now, high schools teach quantum mechanics.

Medicine is not so different. We do so many things simply because of tradition. Why take 30-hour call shifts every 3 nights? Because the attendings did it back in their day. Why structure the day around rounds or the hospital around wards or residency funding around inpatient rotations or reimbursement around insurance company battles or litigation around case-law? Certainly in some or most of these aspects, we're doing what's optimal. But in order to advance medicine, we must not get locked in the past; otherwise, advancement is simply waiting for us to pass ourselves. Creativity, innovation, and change are the core of all our endeavors.

Image of Max Planck from 1910 is in the public domain, taken from Wikipedia.