The Joy of Not Knowing
by Namrata Kantamneni
Image source: Unsplash
In the vast ocean of knowledge, how much do we actually know? How do we validate what we know? How much lies undiscovered?
As a first-year medical student, these are the questions that came to the forefront of my thoughts as I sat in a lecture hall, learning about the biopsychosocial model of pain. I found it peculiar that in the 21st century, an era filled with AI and precision cancer therapeutics, there is still so much that we do not know about pain and pain management.
But what about pain makes it so enigmatic? While there are many theories, ranging from neurotransmitter regulation to gate-control theory, I like to think there is still a certain unmeasurable quality of pain, which arises from its intrinsic subjectiveness.
Today, our metrics regarding pain measure external manifestations of an internal process that partially occurs in the mind. We measure facial expressions, markers of inflammation, or simply ask the patient to rate their pain out of 10. As we progress and develop more advanced imaging techniques, we may be able to measure neuronal firing in the brain.
However, these are all extrinsic measures of pain. Even measuring the firing of neurons is not measuring pain itself, instead measuring the physical brain’s manifestation of the pain felt by the mind. Pain, fundamentally, is a subjective experience. Reducing pain to a simple biological mechanism is hubris.
The more I thought about this, the more I realized that many disease pathologies are similar to pain. There is something highly personalized that makes a disease manifest differently in every patient. Even if we look at something as objective as rheumatoid arthritis, the symptoms manifesting in each patient differ: some people have high levels of antibodies, while others will only have physical manifestations of stiff joints in the morning. The “ideal” manifestation of a disease that we encounter on board exam questions often only exists in textbooks.
So what makes each person’s pathology different? How do we set statistical thresholds, like sensitivity and specificity, for a specific diagnosis on a population level, while still understanding that an individual patient’s threshold might be different? Can a specific disease even exist as its own concept outside of each individual human? We learn pathology by studying groups of humans with specific disease pathologies, but how do we recognize the fact that the same pathology can manifest differently for each individual person? If a pathology can manifest differently for each patient, how do we then come up with clinical standards and definitions for that pathology, given its inherent subjectiveness?
As I learn about medicine, these are the questions that excite me. At the end of the day, there is so much we have yet to discover and question. And I believe that the best part of medical school is not how much we learn, but how much we don’t know.
Namrata Kantamneni is a second-year medical student at the UTCOMLS.
