Demystifying Medicine One Month at a Time

Tag: medical uncertainty

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 HealthNewsReview.org. Gary has devoted his latter career to debunking medical hype. His site is well worth perusing.

Uncertainty

Let’s say that you’re sick enough to be admitted to a hospital in the U.S.

You’d feel somewhat assured knowing that you were in the hands of experts, that no stone would be left unturned in trying to find out what’s wrong with you and how to make you feel better.

But what happens when medical experts disagree on things?

I recently posted about a friend of mine, who has a mysterious illness that seems to defy categorization. He’s fortunate enough to have had the opportunity to consult with some of the country’s leading experts (in no fewer than four different cities!) regarding his condition.

After nearly a week in a Boston hospital failed to cinch a diagnosis, he even turned to the Web to solicit input and ideas from colleagues, readers, medical types, and the lay public (probably House fans).

A blog account of his hospital travails turned up a few obscure references from the medical literature (including one from a Korean medical journal) that have definitely had bearing on his clinical situation and what steps he should consider next.

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