Demystifying Medicine One Month at a Time

Medical Revolution(s)?

9780465050642This week an essay in the New England Journal of Medicine asks if our collective learning to handle uncertainty should be ‘the next medical revolution.’ It caught my eye because many of the medical educators I follow on social networks were abuzz about it.

Coincidentally, I’m reading a fuller-length exploration of medical uncertainty, a book called “Snowball in a Blizzard,” by Steven Hatch, an infectious diseases doc at UMass.

Both the essay and the book remind us to have humility: though medical technology and scientific knowledge have leapt ahead and continue to hurtle forward, our profession’s abilities to diagnose, treat, or predict future health outcomes with precision remain stubbornly elusive.

The metaphor of the ‘snowball in a blizzard’ comes from the world of radiology–in particular mammograms. That’s what radiologists who read mammograms are looking for on the images they see. It’s challenging and inexact work. Often they miss tumors that are cancerous; to correct for this, it’s natural that radiologists need to be extra cautious and have women with anything even remotely suspicious follow up for more images and possibly biopsies. [With negative biopsies, such mammograms become known as ‘false positives.’]

I agree with the thesis that we should all become more comfortable with uncertainty. But it will be challenging.

As patients, we want our doctors and scientists to be able to give us predictions that are accurate.

  • Is this the right diagnosis?
  • Will this treatment work?
  • How long have I got?

As doctors, we wish we had greater ability to answer these questions.

As ‘consumers,’ we are fed an unending stream of media that tell us what we ‘should’ do, what we ‘need’ to be healthy, and what will make us live longer. Much of it never offers the necessary caveats about the inexactness of the science. This will be an uphill battle.

I was pleased to see a chapter in Hatch’s book devoted to health media, featuring Gary Schwitzer and his website Gary has devoted his latter career to debunking medical hype. His site is well worth perusing.

1 Comment

  1. Don Baker

    I caught the tail end of Medial Mondays (Nov 7th) & can’t recall the name of the author whom you interviewed, or the title of her book. Nor can I find any reference to it on or @glasshospital. If you think that all medicine is healing, and that those of us with mental illness could be healed by it if only we had the wisdom to allow it, just check yourself into the Tulsa Center for Behavioral Health. Or read this book:; Nor do you seem to know about Oklahoma state mental health law, Title 43A, which defines anyone with a mental illness as “in need of (involuntary) treatment” on the mere allegation that such a person has caused another to feel a reasonable fear of threat. All bigots are reasonable – just ask one. Like many States, Oklahoma has created special law for people with mental illnesses, which is just as capable of abuse as Jim Crow. Or, as one staff counselor in TCBH so clearly put it: “It doesn’t matter if you like it or not. It doesn’t matter if you agree with it or not. All that matters is how people perceive you.” For some if not all of us, there is no difference between that kind “help” and last paranoid child abuser. There is no difference between Mental Health Court and the Star Chamber, another institution set up for the benefit of its “consumers.”

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