Obscurity in Medicine

photo by Josh Scholten

Be obscure clearly.
~E. B. White

As a family doctor, I work at clarifying obscurity about the human condition daily, dependent on my patients to communicate the information I need to make a sound diagnosis and treatment recommendation.  To begin with, there is much that is still unknown and difficult to understand about psychology, physiology and anatomy.  Then throw in a disease process or two or three to complicate what appears to be “normal”, and further consider the side effects and complications of various treatments — even evidence-based decision making isn’t equipped to reflect perfectly the best and only solution to a problem.  Sometimes the solution is very muddy, not at all pristine and clear.
Let’s face the lack of facts.  A physician’s clinical work is obscure even on the best of days when everything goes well.  We hope our patients can communicate their concerns as clearly as possible, reflecting accurately what is happening with their health.  In a typical clinic day we see things we’ve never seen before, must expect the unexpected, learn things we never thought we’d need to know, attempt to make the better choice between competing treatment alternatives, unlearn things we thought were gospel truth but have just been disproved by the latest double blind controlled study which may later be reversed by a newer study.   Our footing is quicksand much of the time even though our patients trust we are giving them rock-solid advice based on a foundation of truth learned over years of education and training.   Add in medical decision-making that is driven by cultural, political or financial outcomes rather than what works best for the individual, and our clinical clarity becomes even further obscured.

Over thirty years of doctoring in the midst of the mystery of medicine — learning, unlearning, listening, discerning, explaining, guessing, hoping,  along with a little silent praying — has taught me the humility that any good clinician must have when making decisions with and about patients.  What works well for one patient may not be at all appropriate for another despite what the evidence says or what an insurance company or the government is willing to pay for.  Each person we work with deserves the clarity of a fresh look and perspective, to be “known” and understood for their unique circumstances rather than treated by cook-book algorithm.  The complex reality of health care reform may dictate something quite different.

The future of medicine is dependent on finding clarifying solutions to help unmuddy the health care decisions our patients face. We have entered a time of information technology that is unparalleled in bringing improved communication between clinicians and patients because of more easily shared electronic records.  The pitfall of not knowing what work up was previously done will be a thing of the past.  The risk and cost of redundant procedures can be avoided.  The patient shares responsibility for maintenance of their medical records and assists the diagnostic process by providing online symptom and outcomes documentation.   The benefit of this shared record is not that all the muddiness in medicine is eliminated, but that an enhanced transparent partnership between clinician and patient develops,  reflecting a relationship able to transcend the unknowns.

So we can be obscure clearly.   Lives depend on it.

2 thoughts on “Obscurity in Medicine

  1. My husband and I are both diabetic. He is 65 and I am 72. We have recently dropped our Hba1c from 7.3 to 5.7. We did this following the functional medicine program of Dr. Mark Hyman at bloodsugarsolution.com. My husband took the supplements recommended; I did not. His Hba1c dropped further than mine and we have both lost over 20 pounds in 4 months on the program. I highly recommend this program for any of your patients with diabetes who are struggling to avoid insulin.

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  2. I failed to clarify that we are Type 2 diabetics and trying to control our blood sugar with diet, exercise and drugs. We would like to control it with just diet and exercise and eliminate all the drugs with their nasty side effects. The diet we are following is almost primitive, returning to pure, wholesome and organic foods, few if any processed foods, and no alcohol, caffein or sugar. We are also eliminating wheat and dairy because of sensitivity to those foods that influenced our weight gain dramatically, thus our weight loss just as dramatically and painlessly. We enjoy a life style that is now no longer burdened by calorie counting and obsessing over diaries of what we have eaten each day. It is a glorious renewal of our energy and vitality that has given even our marriage a new boost of delight in each other. Thank you for listening.

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