Take a dab of Werner Heisenberg and a dollop of Jimmy the Greek, throw out a chunk of Isaac Newton and you've got a recipe for what's new in medicine.
Not only that, you may have the anatomy of a paradigm shift, the blueprint for a whole new approach to the practice of medicine, a raison d'etre for doctors themselves, an apologia for the discipline of medicine and, most importantly say the authors of this contained revolution, a blending of the art of medicine with the science of medicine.
"One of our intentions," says Dr. Richard I. Feinbloom, graduate of Harvard Medical School, family practitioner and teacher of family practitioner interns from his alma mater, "was to address the real ferment in medicine that comes from the critique of the holistic health movement, the consumer movement, the patient rights movements, the patient advocacy approach."
We are trying, he says, "to reach for a context which can rationalize all these and synthesize them and bring them together."
Feinbloom and a cerebral committee of colleagues spent some months chewing over the seeds of medical revolution that would topple the physician from the pedestal he has occupied unchallenged for the past century or so. And from these sessions has been produced a provocative and perhaps seminal approach.
In a sense, Medical Choices, Medical Chances (Delacorte, $14.95) could be viewed as a fire break, one of those deliberately-set fires designed to head the conflagration into a less destructive direction, to contain it, to subsume it.
It began, says Feinbloom, merely as a "batting around of ideas" by a couple of doctors who felt troubled and isolated, faced with seeming conflicts and inconsistencies in the way medicine was practiced.
Feinbloom, the family practitioner, says he "felt it was terribly important to do more than simply claim that (the discipline of family medicine) was good and important, but really to demonstrate its own scientific base of understanding, to legitimize it," something which had not been done in the discipline's decade or so of existence.
He found an avid discussion partner in his then Harvard intern Harold Bursztain. The second of the book's four authors, Dr. Bursztain is now a resident in psychiatry at the Massachusetts Mental Health Center and next year will be chief resident in forensic psychiatry.
As an undergraduate at Princeton, Bursztain has studied philosophy, quantum physics and mathematics. Indeed, he took off a year between his third and fourth years in med school to "take a crack at interpreting the medical scene vis-a-vis the paradigm shift which has already occured in physics," says Feinbloom.
This was the shift brought about largely by the work of German physicist Werner Heisenberg, the fatal challenge to the absolutism of Newtonian law. The Heisenberg "uncertainty principle" holds (oversimply stated) that what is observed is changed by the act of observing. Electrons under the light of the electron miscroscope did things differently than they did nobody was looking. Like people. Enter probability.
(Feinbloom says that part of Bursztajn's interest in uncertainty stemmed from his parents' wartilme experience. They were holocaust survivors, kept hidden throughout the war in a bunker deep under the ghetto in the Polish city of Lodz. They escaped during the upheaval caused by the Russian occupation.)
"It was seeing," says Feinbloom, "if some adaptation or application of that shift in physics could be made in the medical profession that would clarify the things we were seeing as inconsistencies and problems in our work. That is, what seemed (to us) to be important didn't fall within the purview of science. It was relegated to the art of medicine or humanistic medicine or holistic medicine. . . .
"It was sensitivity to those aspects of the patient that were being given lip service and not really viewed as part of the scientific method itself. . . . It was as often as not acknowledged in not doing it as much as in doing it. If you had time, you did it. But often you didn't have the time because you were in a big hurry and you had so many more important things to do, like getting cold, hard facts. . . ."
"Because," says Feinbloom, "for many years, doctors have behaved as though (interaction) just didn't happen in the doctor/patient relationship. Somehow the patient is looked upon as something that wasn't affected by the way the doctor behaved, so it didn't really matter."
Now enter author three: Ph.D. psychologist Robert M. Hamm, a friend and former classmate of Bursztajn's and a specialist in the psychology of decision making.
It was Hamm who made the connection between the probabilities of quantum and the probabilities of everyday life, and came up with gambling. And it was the concept of gambling which gave the three scientists and writer Archie Brodsky (author four) the structure of their paradigm shift in medicine. The old medicine, that of the hard science, find-the-cause-then-cure-it medicine, they call the "Mechanistic Paradigm." The new one is the "Probabilistic Paradigm."
The book is structured as the odyssey of a young doctor who, starting out as an intern, sees a 2-year-old literally diagnosed to death in a modern hospital. It takes him through other cases, most of which are genuine (although camouflaged), including the death of an intelligent, highly motivated woman who believes firmly that responsibility for her health is her own. Her case demonstrates for purposes of the book's argument that holistic medicine alone is not enough of a change because, once again, it discounts the interaction of doctor and patient.
Says Feinbloom, "Under the rubric of the new science of probability we can learn some very important messages in terms of science and medicine.
"We can begin to apply some principles of medicine which will allow for a unification of the objective -- the hard, cold facts -- and the subjective -- the feelings, values and attitudes that people have -- and allow us to see them not as parts of a dichotomy, but as different ends of a spectrum. And to ignore feelings, values and attitudes, the subjective side of things, is to be unscientific in the 20th century.
"Far from what is often propounded as the "Mickey Mouse" aspects of medicine -- paying attention to what patients feel -- we propose that in 1981, that to NOT pay attention to feelings and values and attitudes is really to be less than scientific.
"The nice thing," says Feinbloom, "is that it really fits in about what we know instinctively anyway, that feelings really do count, and the way you feel about your doctor matters, and the kind of trust you have in your doctor matters. It's important. And it's important you let your doctor know what is important to you."