The absolute truth

An absolute truth, sometimes called a universal truth, is considered to be an unalterable and permanent fact. The concept of what is an absolute truth and whether there really is such a thing as a truth that will never change has been debated by many different groups of people, and philosophers have tried to define it ever since they started thinking.

The truth is that many of these thinking minds believe in relative truths, where facts may vary depending on the circumstances.

Are there any absolute truths in science? Truth or fact?

Is there anything that science will prove, forever and ever, without any changes through time and evolution of knowledge? The reality is that a scientific “truth” is a truth based on a scientific consensus, a collective judgment, the position and opinion of the community of scientists in a particular field of study.

Consensus implies general agreement, though not necessarily unanimity.

Medical absolute truths

In the field of medical science there are some things that have been widely considered as so called absolute truths – truths or facts that will never change. Or will they? Some might …
▪ An accurate diagnosis will not be reached in every case.
▪ There will always be questions for which answers cannot be found.
▪ A proven treatment will not work for every patient.
▪ Every treatment will have potential adverse effects.
▪ Injuries will happen, they cannot all be prevented.
▪ Infections, viral, bacterial, fungal and parasitic, will occur. They cannot be eradicated, they cannot all be prevented.
▪ Genetic aberrations will cause diseases, they cannot all be prevented.
▪ Patients will honour a physician more for his/her caring attitude and charming personality than for his/her knowledge.
▪ People with inadequate medical knowledge or training will interfere with the appropriate treatment.
▪ New diseases will appear.
▪ People will die … will this ever be changed?

And, the most important of all truths is, that all truths will change when greater truths are discovered, as science develops.

Clinical judgment

Clinical judgment consists of the application of information, based on the actual observation of a patient, combined with subjective and objective data leading to a conclusion and to critical decisions for medical actuation when treating a patient.

These decisions are not only made on the basis of scientific knowledge and accurate observation but also on the skills provided by long experience in similar cases.

Not to be forgotten is the innate ability to make balanced judgements based not only on the actual state of the person and his/her predictable future but also his/her overall wellbeing.

Let us consider the example of High Blood Pressure (HBP). It is generally accepted that “normal” is 120 of systolic over 80 of diastolic but, even if this is considered ideal, it is not an absolute truth for everyone, as there are several conditioning factors that will dictate a more or less aggressive intervention.

The initial evaluation of a patient with hypertension calls for BP measurement, medical history including family history, physical examination, laboratory investigations and further diagnostic tests. Some of the investigations are needed in all patients, others only in specific patient groups and each patient is a special and different patient, not just … a blood pressure.

Blood pressure measurements alone are not enough to determine treatment options.

Clinical Practice Guidelines

Guidelines are tools for clinicians to use in order to improve their own medical practice, their patients’ outcome and globally the healthcare system, based on a systematic review of the actualised literature to provide recommendations based on the best available evidence.

Finally, in the end, the last aim is to help clinicians to deliver the best healthcare possible.

Practice Guidelines are the closest facts to “temporary absolute truths” that can be made available based on summaries of recommendations from a variety of international and national organisations regarding controversial topics, in screening, prevention and treatment management.

Guidelines may lose their clinical relevance as they age and newer research emerges.

So all this goes for blood pressure, cholesterol and antibiotic use, anything regarding health management.

Thus it is not easy to define a totally secure, beyond any doubt, way of acting, as there is no absolute truth. Truth is not unique. It depends on people’s variety, it moulds to the individual. This is why it is so important for the treating family doctor to know the individual characteristics of each patient/client in order to achieve the personalised, individualised, adequate truth.

The absolute truth is not achievable, it is a mirage.

But, after all, it is not absolutely necessary.

The most important thing is to achieve each person’s best absolute truth.

Best health wishes,
Dr. Maria Alice

By Dr Maria Alice
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Dr Maria Alice is a consultant in General and Family Medicine. General Manager/Medical Director – Luzdoc International Medical Service / Medilagos. Medical Director – Grupo Hospital Particular do Algarve