Thread by @medicalaxioms

One of my career goals has been to create a new field of medicine. I think I’ve finally got it. Come along with me while I make my case. [thread, y’all]

We all know the Infectious Diseases doctor. She is super helpful when the patient is sick with or dying from an infection. She knows a lot about him a beings and their signs and symptoms. Mostly “flu-like” symptoms but you get the idea...

When I talk with my infectious diseases specialists I am always amazed what they know about people AND a whole zoo of other vermin. Bacteria, viruses, fungi, protozoa, amoebas, the list goes on and on.

That’s not all! Infectious Diseases doctors also know about vectors. Mosquitoes. Sheep, prairie dogs, armadillos, parrots, rabbits, mice, snails, oysters. ID doctors know a bunch of stuff about the whole zoo.

Why?

Because they have to know that stuff to diagnose, treat and prevent the morbidity and mortality associated with all the infections in all the vectors and hosts that sicken human beings.

The knowledge about all the animals, bugs and microbes helps them take care of people. Treat and prevent illness. Save lives.

Of all the creatures that swim, slither, crawl, walk and fly, there is one that presents a most extraordinary threat to the health and survival of any one of us trying to live out a healthful life on earth.

Curiously, I feel like I know more about Staphylococcus aureus than I do about this creature. It seems to be protected from study and ignored by the field of medicine despite its virulence.

It’s us. People. Humans.

The ways we threaten each other’s health are manifold.
- violence
- abuse
- isolation and exclusion
- drinking and driving
- selling each other drugs
- wars
- famine within view of wealth
- you know, the whole news cycle.

Now, your first reaction should be “that’s not medicine” or “those are social problems” or “don’t get political” or “your mixing apples and battleships.”

I know because I’ve been wrestling with this for a few weeks now. Work with me. Stay objective.

Let’s call this field of medicine “Humanology”

Let’s define it as: Study of the influence of other human beings on the health of the individual.

There. That wasn’t so bad.

Now before we do anything else let’s decide which of these patients gets a Humanology consult:
1. 28 F in the ER with a broken arm & black eye from “fell down”
2. 52 M community acquired pneumonia
3. 52 M TB pneumonia
4. 22 M GSW outside restaurant
5. 22 M GSW, self-inflicted

I’m a skeptic so I am ready for you. The problems listed are
- social work
- psychiatry
- religion
- free will
- bad luck
- not our business
- “just things that happen”
- human nature.

I get it. Just sew up the aorta and move on.

This keeps nagging me though. Why do I know so much more about Staph aureus than people who hurt and kill other people?

For microbes, I know their reservoirs. Where they hide. Where they multiply, the conditions they thrive in, their genes. I know a little bit about the most benign ones and a lot about the protozoa Plasmodium.

Why don’t I know more about the subset of people who pose the highest risk to health? Where is that textbook? Who is doing that study? We are dangerous and under-examined.

One way to think of this is “bedside public health.”