"If it’s going to clash with reality so much, why couldn’t they just reflect reality in the textbooks in the first place?"
This is a question that naturally comes to mind when agonizing over realistic solutions. If the textbook answer is a perfect one that no one can keep anyway, shouldn’t we just teach a "reasonable compromise"—something patients can easily follow—as the standard from the very beginning? However, there is a very good reason why medical textbooks stubbornly insist on pristine, noble answers, looking much like an impractical scholar who knows nothing of the world.
It is not because the textbook is ignorant of reality; rather, it is a stubbornness born from knowing reality all too well.
Guarding a Baseline That Has Begun to Crumble
The greatest raison d’être of a textbook is to establish a "Standard." The center holds only when the best possible state based on scientific evidence—the "Gold Standard"—is explicitly defined.
What would happen if textbooks compromised with reality and lowered the bar? What if, instead of the rule "Exercise for 30 minutes every day, five times a week," it reflected reality and read, "Everyone is busy, so just do it once a week for 20 minutes"?
Regrettably, human psychology will attempt yet another compromise from that lowered standard. The moment 20 minutes once a week becomes the official correct answer, people will take another step back, saying, "I’m busy this month, so I’ll just do it once a month." Guidelines must always point toward the most ideal target. Only then, no matter how much people compromise and break down in reality, can we defend the "maginot line" that yields at least a minimum effect.
Eight Billion Lives Cannot Be Turned into Data
The knowledge contained in medical textbooks is "science" that has undergone statistical verification and clinical trials involving thousands or tens of thousands of subjects. The proposition that "consuming 50mg of Component A per day lowers blood pressure by 10mmHg" can be proven with numbers.
However, the "reality" we face can never be standardized by numbers.
One patient suffers from the temptation of late-night binge eating due to night shifts that flip their days and nights. Another patient, tight on budget, gets by on convenience store bento boxes instead of fresh vegetables. Yet another patient is full of willpower but suffers from a mental illness so deep that even stepping out of bed feels overwhelming.
If a textbook were to include specific instructions like "Dieting for Frequent Night Shifters," "Meal Plans for Low-Income Earners," or "Exercises for Those with Depression," even tens of thousands of volumes would not suffice. A textbook is a book that contains the "universal rules of human cells," not one that can encapsulate the "lifestyles of eight billion people."
A Safety Net Named ‘Perfect Principles’
Lastly, textbooks serve as a sort of legal and ethical "safety net" for healthcare professionals.
If a doctor prescribes the safest and most reliable principle found in the textbook, it is not the medical staff’s negligence even if the patient’s condition does not improve as intended. If a textbook were to exhibit flexibility and state, "If the patient finds it too difficult, agree to let them smoke about three cigarettes a day," and the patient’s lung disease worsens, who would bear the responsibility? Textbooks have a duty to contain only the most conservative, unbiased "best facts."
Anomalies Shine Only When Principles Hold Fast
To use an analogy, a textbook is a basic recipe book that states, "To make the best dish, use the freshest organic ingredients and exact measurements."
However, when you actually open the refrigerator of the clinical field, there are no such things as organic ingredients. There are only ingredients whose expiration dates are fast approaching. At this moment, the chef (the healthcare professional) must temporarily close the recipe book and create the most palatable dish possible out of the crude ingredients currently at hand.
If the recipe book had said from the start, "Just wing it with whatever is left in the fridge," no one would ever be able to learn the basics of cooking.
Because the textbook firmly holds the center with perfect "principles," paradoxically, field experts can feel secure enough to exercise flexible "anomalies" tailored to the patient’s life. The reason textbooks have no choice but to be cold and resolute is that they must serve as the single, sturdy lighthouse that keeps both patients and medical staff from losing their way on the rough sea called reality.
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