In medicine when we review a case it’s usually because all didn’t go well for the patient. It’s part of our on going effort to improve what we do and how we treat patients. If you’re going to be in any aspect of medicine for long, you have to get used to a certain level of scrutiny. Often, looking back at a case we can see where we might have gone wrong. The problem is that we had to go with what we knew at the time, not what we were going to know after the case was over. The less the patient can help us to treat them, the more likely it is that something that would have been extremely helpful won’t be known until later on. If we ever know it.

When we review a case, we look at what we knew about the patient and also what we should have known. That is, did we miss something that we should have seen, or did we not ask a question we should have asked? Did we forget to ask or look for a list of medications or allergies? A good example of this is forgetting to ask a patient, male or female, if they are on any of the medication commonly prescribed for erectile dysfunction. The use of that class of medication has gone beyond helping males to achieve and erection, which is why I included women in my comment. Giving nitrates to patients on those types of drugs can easily harm a patient.

That’s the type of thing we should know about and shame on us if we don’t.

Then there is the type of stuff that we couldn’t know about because there is just no way to know it without the patient telling you or it being written down somewhere. For example, does the patient take drugs that might interact with what we plan to administer? Sometime you just can’t know. Secretary of Defense Donald Rumsfeld referred to two types of unknowns. There were things that you knew you didn’t know, and you could plan around them. Contingencies in case something that might happen, but can’t be predicted actually happen. Then there are the “unknown unknowns”. These are things that you can’t reasonably predict might happen and so it’s hard, if not impossible to prepare for them. Patients are full of surprises, sometimes they just don’t do what the text book tells us that they should do. In which case our treatment plan goes to hell in a hand basket and we have to react quickly to keep things from getting out of hand. Often, after the call, the  missing pieces fall into place and we now know that which would have been very helpful in the heat of battle.

In medicine we refer to a mythical piece of medical equipment known as the “Retrospectrocope”. It’s a wonderful piece of equipment that allows us to see things in the past with complete clarity. The problem comes when other people apply the Retrospectroscope to our actions and scold us for not knowing something at the time that they can clearly see in the present because they have all the information that we would have loved to have had, but just couldn’t. It’s a cheap sort of criticism intended to produce a sense of superiority in the observer and a sense of failure in the provider. It’s a low way to operate and fortunately in medicine it’s not that common.

So now I’ve used about 600 words to describe something that we do in medicine, in a post that really doesn’t have anything to do with medicine.

I told you all that so I can tell you this.

It seems that the Retrospectroscopes are in full use this week in regards to the Boston Marathon bombings and the aftermath.

We find that the FBI knew about one of the bombings and should have done something. The fact that they had no probable cause to arrest him, or even keep him under surveillance seems not to matter to these people. Who, if they found out that the FBI had been keeping him under surveillance, would have complained about the United States turning into a police state and protested that his civil rights were being violated.

The police shouldn’t have locked down Boston and some other cities around Boston. It’s a police state! Never mind that the two bombers were now identified and there was an active manhunt on for them. Never mind that during that manhunt they shot and killed one police officer and shot and critically wounded another one. Or that they threw explosive devices at police and had no hesitation about engaging the police in a fire fight. Or that they carjacked a person and the only reason that they didn’t kill him was that they didn’t think he was an American.

The police were incompetent and the only reason Suspect #2 was caught was because a citizen happened to find him hiding in a boat. The police had been searching for almost 24 hours. They had searched that boat earlier, which to me means that Suspect #2 moved around. Was he hiding in one of the houses? Maybe. The police only searched when they were invited to by the residents. The police had stopped searching for the day, but hadn’t given up. They still suspected he was in the area, they just hadn’t found him yet. I don’t care how many officers there were in the area, it’s damned hard to find someone when they don’t want to be found.

The police were too brutal in shooting Suspect #1.  I don’t have a publishable response to this one. Some people are just so self absorbed and stupid that they can’t be reasoned with. What’s really stunning is that someone pays this nitwit to teach college students. I’m reminded of Colonel Jessup’s speech from A Few Good Men. It’s easy to criticize people when you don’t have to do what they do or pay the price that they do.

Everyone in the affected areas should have/should not have had a gun ready. All the arm chair commandos, both amateur and professional are sure that that THEY would have been able to capture these people if only they were there with their guns. Anyone who reads this blog knows that I own guns. I’m often armed as I go about my daily business. I’m fairly proficient with a firearm, but I’m not a fool. The reason I carry a gun is if all else fails and my life is in danger. If the police were chasing a suspect in my neighborhood, then I wouldn’t run around outside with a gun. No Dr. Keith Ablow the police shouldn’t have told the people in Watertown to “get their guns”. The people in Watertown and likely everywhere else who own guns probably figured that one out on their own. I know a lot of people I know did.

I just wish that people would turn off the Retrospectroscopes and stop making fools of themselves with criticisms which they are totally unqualified to make.