Page 26 - Hall et al (2015) Principles of Critical Care-McGraw-Hill

Introduction

Science, Belief, and Intuition in the ICU*

Lawrence D.H. Wood

The intuitive mind is a sacred gift the requisite controls make some experiments so cumbersome that the
The rational mind is a faithful servant question under study is obscured.
Not too long ago, scientific principles were not known or practiced,
We honour the servant so another method of inquiry prevailed. Belief is a habit or state of mind
And have forgotten the gift. which places trust in an idea or person without convincing evidence.
—A. Einstein Although many trace their system of beliefs to their mother’s knee,
modern neuroscience ascribes to the brain a function to help the organ-
4
Knowing and doing the right thing for our patients is a goal of our ism cope with its environment. Table 1 (right column) is my attempt
profession. How one arrives at each choice among many is a process to organize the corresponding steps for belief to those of the scientific
worthy of consideration. Yet there are few methods of inquiry to search method. When the brain notices disparate objects not seen together
for new knowledge to help our patients. This introduction discusses the before (see step 1, right column in Table 1), it makes up a myth—a belief
scientific method and proposes a spiritual source of knowledge which to explain the phenomenon (step 2). Beliefs are often subjective and
complements science. Reflection on my life revealed a lot of science and not measureable, such as God or spiritual issues, so step 3 expects to
many beliefs. Seeking to answer life’s questions by living the interface of see it again as originally developed. Because it cannot be measured, and
science and belief, I stumbled on intuition and the still small voice as falsified, there is no corresponding disproof of step 4 for belief, unless
overlooked contributions to finding answers. I hope that many of you a credible witness can verify the belief. Then we can choose among the
will find part of yourselves in my deliberation. innumerable beliefs the explanation most likely to verify the phenom-
enon, generating an intuitive source of knowledge for those physician
SCIENCE AND BELIEF: METHODS OF and scientists who seek it. I propose that belief most resembles science
when the still small voice or intuition verifies that belief. Many look
INQUIRY AND KNOWING down on such beliefs as a method of inquiry because they are strongly
Science is the evidence-based generation of knowledge. The scientific personal, cannot be externally verified, are not subject to falsification
method was developed to reject erroneous hypotheses because people and can arise from preconceived ideas. Yet it is compatible with science
observe what they expect. Table 1 organizes the sequential steps for sci- to keep an open mind about explanations that have not been falsified.
1
ence (left column). Step 1 provides the background to the question from Interface is the site or process where two independent systems act on
observation and experience, and step 2 proposes an explanation—a each other, such as science and belief as different methods of inquiry.
hypothesis usually expressed in the negative—the null hypothesis (H ), Many transactions in my life are living this interface where I feel, think
O
meaning that any difference observed between groups being studied and work toward processing the integrated systems with ceaseless striv-
is not due to one of the groups having been affected by the interven- ing to understand or with active receptivity for revelation.
tion being studied. Step 3 makes a prediction from the H , and step 4
performs experiments to disprove the prediction and so falsify the H . AN ILLUSTRATIVE CASE
O
2,3
O
Living in an age when most new knowledge is generated by the scientific It was 10:30 pm when my home phone rang. The dean’s message was
method makes most think there is no other way, but science has limita- terse: “Larry, the 30-year-old daughter of a friend is moribund in the
tions. When followed rigorously, the scientific method is tedious and ICU of a nearby hospital. He asks that you see her.” At her bedside an
slow, it handles subjective hypotheses of great importance poorly, and
hour later, my examination confirmed her hyperactive circulation and
low blood pressure (90/40) likely due to a serious infection (T = 39°C),
TABLE 1 Sequential Steps for Science and Belief complicated by excess liquid in her lungs with 4-quadrant air space
Steps Scientific Method Steps Belief filling on her chest x-ray, due in part to excess circulating volume as
indicated by a pulmonary artery occlusion pressure (PAOP) of 24 mm
1 Characterization from experience 1 Noticing co—variables not seen Hg. She was intubated and ventilated with 100% oxygen, positive end
and observation before expiratory pressure (PEEP) of 20 cm H O, and a tidal volume of 800
2
2 Hypothesis: a proposed explanation 2 Develop a myth mL at 20 breaths/min. She was oliguric, comatose, and receiving a large
3 Deduction: prediction from the 3 Expect to see the myth, as devel- intravenous dose of broad spectrum antibiotics.
hypothesis oped above, again As I examined her, I prayed silently “Lord, Agnes is dying, what
4 Test and experiment 4 Confirmed/denied by still small voice can I do to help her get better?” Out of the noisy background of her
ICU cubicle, through the bells and whistles of alarm systems and the

*This introductory chapter was modified with permission from Chapter 6 of the recent book also authored by LDH Wood, Science, Belief, Intuition: Reflections of a
Physican. Balboa Press, Indiana; 2012:46-53.
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