For those of you not in clinical medicine, you may or may not have heard of the retrospectoscope. It is a very powerful diagnostic tool. It is almost never as useful as doctors wish it could be and in the wrong hands it can be dangerous. The scope is used to look into a clinical scenario from the perspective of time and with knowledge of the outcome of the event. In a malpractice trial, for example, the expert is often asked a question like “In your opinion, had the deceased been given a single dose of penicillin before her death, would the death have happened?” When the expert strokes his or her chin, and says “In my opinion, yes, the drug would have saved that patient’s life,” THAT is how retrospectoscope is used,

For those of you who are purposely avoiding current events, a former honors student in neuroscience took an arsenal into a movie theater early Friday morning and shot up the place, killing 12 people. This is a point in time where, if “something” had been done different, folks would not have been killed or injured by this lone gunman. Depending on one’s ability to look into the “scope,” it may be that the gunman was mentally unstable and this is a cry for more and better mental health care (is anyone who walks into a theater and shoots people stable?).  In fact, as evidence mounts that the alleged killer purchased his arsenal and ammunition (6000 rounds) within 60 days of the incident, it seems clear that anyone with that kind of behavior should have been under surveillance, doesn’t it? Though you may not have a home retrospectoscope, I guarantee you that CNN, Fox, and MSNBC have their commercial models running in overdrive.

It is my experience (time for me to use the retrospectoscope now) that there are a whole bunch of messed up people who are able to perform well in school (some on their own, some with the assistance of pharmacology) but have limited interpersonal skills and ability to interact with others. Occasionally, one of these people acts out, sometimes in a spectacular way (such as this) but often in a run of the mill way harming one or several people who may or may not have been trying to help. It is also my experience that we have stigmatized and  reduced resources, such as college counseling centers, designed to help these folks transition into meaningful career paths. We have medicalized a lot of education but are complicit in working with the system for the highest academic achievement instead of taking a more holistic approach. Lastly, we physicians have tolerated the commodification of weapons that exist only to cause harm to other human beings.

I don’t like using the retrospectoscope. The images are too clear and always point to the bad outcome in question. I do wish we would provide more resources to assist adolescents as they transition into adulthood. What kind of scope should I use to see that?

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