It is the end of June, but the beginning of the year for the new pediatric interns, and I am their supervising physician. They are enthusiastic and booksmart, but green and uncertain about patients. On the oncology floor, the story often sounds the same. A two year-old boy with leukemia has fever and neutropenia. A 10 year-old girl with a different type of leukemia has fever and neutropenia. A fourteen year old with osteosarcoma has fever and neutropenia. Fever and neutropenia – the collateral damage of the drugs, which will cure them, hopefully, of their cancers. Neutropenia means a shortage of infection-fighting white blood cells. And like a fever, neutropenia comes in grades. The causes for fever can be many, and so the treatments can vary widely. Like a stereotypical hard-ass physician often seen on a television doctor show (the most recent example is Dr. House), I could pimp the interns to list the many different causes of fever. But what would they learn. Which antibiotic to use? should we add an antifungal agent? When can we send the child home?
Instead of badgering them to provide a stream of consciousness of infectious organisms, I take a different tack. Is there something on physical exam, like a mouth sore or rash. How high is the fever. How low is the white cell count.
Their goal is come up with a therapeutic plan by distilling from their years of memorizing facts, cramming for multiple-choice exams, and reading textbooks heavier than a newborn baby. My goal is to teach them to think, because I believe in the scientific method of inquiry. Years of caring for patients, years of conducting research into how blood cells become cancerous, and years of writing or reviewing grant proposals to fund that research have convinced me that a methodical approach to any medical problem can resolve it.
Most people last hear about the scientific method sometime at the start of high school biology. Remember, how it goes? In the beginning is the question. Then there are the initial observations. We make an hypothesis, then design a critical experiment, better yet a set of experiments, gather the experimental data, analyze the data and validate, negate, or modify the hypothesis. Importantly, the data must be objective and accurate.
The scientific method, I have learned, is not just for scientists. Doctors use it to diagnose and treat their patients, like our patients with fever and neutropenia. Detectives use it to catch the suspect. Journalists to uncover scandals. Homeowners to find their dream house. Parents to determine whether their children are telling the truth. Men and women to find their spouses.
This may all sound cold, calculating, and reductionist. Yes…but I believe the scientific method works better than anecdote, gut feeling, or tea leaves. No data are perfect. No experiment is complete. Absolute truth remains elusive, but I believe that the scientific method will get us closer to it.
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