Thursday, 16 August 2012




Substantial activity in clinical medicine is not performed on the basis of clear unequivocal evidence

Substantial activity in clinical medicine cannot after care delivery find evidence to back it

Substantial clinical care is delivered incompletely

Substantial amount of errors are found in the delivery of care

Substantial numbers of clinicians are either unable or unwilling to accept the above

In effect there is plenty or wrongness in theory, plenty of wrongness in practice and blindness to wrongness in clinical medicine. The wrongness is affecting patients by causing poor experience of healthcare, avoidable complications and avoidable deaths. Clinical wrongness is also affecting doctors and other clinicians causing variations in practice, restriction in the ability to practice appropriately and punishments for poor clinical performance.

There will be a day in the future when clinical medicine will practiced on the basis of proven science. We will truly rejoice on that day. Till that day arrives clinicians will need an approach that will help in appreciating, understanding and coping with the wrongness that is prevalent. The study of that approach is Clinical Wrongology.

Clinical Wrongology will remove the blindness to wrongness. It will make clinicians appreciate that there is wrong, wrongness and errors everywhere and these are normal to general life and clinicians are not exempt from this. Clinical wrongology will then encourage clinicians to cope with the wrongness around them and will show some methods to practice within the wrongness atmosphere with a view to increasing safety, quality and decreasing cost.
Clinical  Wrongology, the new specialty in healthcare is now declared open.

Watch this blog as there will be more on this subject.

Follow me on twitter @HemadriTweets

PS: While there are philosophers who are masters on the subject of wrongness and great experts in the study of error, my inspiration for thinking about wrongology and clinical wrongology was from 'Being Wrong', Kathryn Schulz's brilliant book. Kathryn if you are reading this blog I hope you do not mind me calling myself a Clinical Wrongologist, (perhaps the worlds first and only one till date); having vainly given myself that title I could be motivated to live up to it; unless I am totally wrong on that!

NB: Persons in healthcare who want to be involved and contribute to this effort, please leave a comment with a means of contacting you or send a direct message to me on twitter.


Endogastromedicine said...

Completely agree in all you said in your blog. I like the term clinical wrongology.
Fear of missing a diagnosis in clinical medicine when approaching a patient makes many doctors to depend on numerous (unnecessary) investigations, time etc.
The fear will not be dispersed unless there is a mentor or guide whom one can approach in case of uncertainity.
The mentor or guide is usually a person who in the eyes of the seeker an expert in that field. However not everyone needs to be an expert to make right decisions

I am unsure when the day will come when everything will proved/disproved in clinical medicine
I dont think it will be in lifetime of clinical practice
Pawan Lekharaju

Rakesh Biswas said...

Being open to the fact that what is right today can be wrong tomorrow requires courage and the ability to deal with one's own vulnerability and this is something that is very difficult to share during 'shared decision making exercises' with other stakeholders in health care such as patients, relatives and even other health professionals. Thanks for your efforts in this direction. best, rakesh

M HEMADRI said...

Thanks Pawan and Rakesh for your comments.
I agree it is not easy but I hope that we will get to a shared decision making method so that even the non-experts can make the right decisions
I will write on this again.

Anonymous said...

Thanks for a very insightful post.
As doctors we need to recognise our shortcomings, and the fact we often treat espite the lack of evidence is a major one.
An opportunity we currently have is to use technology to enable us to build our evidence base incrementally from real time data we collect in clinical practice. For me "big data" in medicine is in gathering clinical data from the entire healthcare system and using it for real time clinical decision support.
I look forward to further discussion on this topic.
Dr George Margelis

M HEMADRI said...

Thanks Dr Margelis for your thoughts on big data and medicine. It will surely interact with you on this one.

Bikash Mohanti said...

Bravo, Dr Hemadri. I salute your "opprobrium ';most appropriate.Ethical" pitfalls" are now effectively marketed as "pearls".
Silence is most discreet. "MUM'S THE WORD".
Tace is latin for "be silent", and candle is symbolic of light.It means "keep it dark", do not throw light upon it.

"Tace , madam, is Latin for a candle"....It was customary at one time to express disapprobation of a play or an actor by throwing a candle on to the stage and sometimes causing the curtain to be drawn.

Major General (Dr) Bikash Mohanti AVSM (Veteran)