The dilemma of modern medicine, and the underlying central flaw in medical education and, most of all, in the training of interns, is the irresistible drive to do something, anything. It is expected by patients and too often agreed to by their doctors, in the face of ignorance.

In this quote, Lewis Thomas critiques a central issue in modern medicine—the overwhelming urge to "do something" in the face of uncertainty. He identifies this as a dilemma in medical education, especially in the training of interns, where the focus is often placed on action rather than on thoughtful observation or understanding. Thomas suggests that patients expect their doctors to act decisively, and doctors, driven by this expectation, may feel compelled to intervene even when they lack sufficient knowledge to make informed decisions.

Thomas argues that this impulse to "do something, anything" is rooted in the flaw of medical training, where new doctors are often encouraged to be proactive and assertive. However, this drive to act can sometimes be misguided and counterproductive, leading to unnecessary or harmful procedures when more conservative, informed approaches might be more appropriate. The pressure to act can stem from the fear of being perceived as passive or incompetent, even when a more thoughtful or restrained approach would be wiser.

Moreover, Thomas points out that this phenomenon is not just a flaw in individual doctors but is embedded in the system of medical education. Interns, in particular, may not yet possess the experience or knowledge to make the best decisions, but the system often rewards actions over caution. This creates a cycle where new doctors are trained to act quickly and decisively, even when they lack the understanding necessary to make the best decisions.

Ultimately, Thomas's quote serves as a critique of both the cultural expectations within medicine and the approach to medical training. By emphasizing the importance of thoughtful decision-making and the recognition of ignorance when it exists, Thomas advocates for a more reflective, patient-centered approach to healthcare—one that values knowledge and careful judgment over simply doing something in response to the pressure to act.