Medicine is an art, not a science. We’ve all heard that maxim before, but what
does it actually mean for living, breathing patients?
Physicians rely upon knowledge and experience when we advise
patients. We try to stay current on
relevant medical studies to guide us, knowing that the latest medical ‘breakthrough’ may be debunked in a few years. Seasoned
physicians resist the temptation to abruptly change their medical advice
based on a single study, even if published in a prestigious journal.
Knowledge and experience are important, but judgment trumps
them both, in my view. The best
clinicians are those who consistently exercise excellent medical judgment.
A knowledgeable physician may be able to recite a dozen
explanations for your high calcium level.
An experienced doctor can expertly perform a colonoscopy
having mastered the technique.
A physician with a high level of medical judgment knows that
surgery is wrong for a particular patient, even though medical textbooks and
journals recommend an operation.
Judgement Outweighs Knowledge
Keep in mind that medical judgments are not right or
wrong. Physicians on the same case may
have differing judgments and recommendations.
This is a typical scenario in the medical universe which can be vexing
to patients and their family.
Consider a few typical patient vignettes which call for medical judgment.
A cardiologist recommends Coumadin , a blood thinner, to start
today to treat a patient’s heart condition.
The gastroenterologist wants to delay this for a few weeks as the
patient has a duodenal ulcer that could start bleeding once the blood thinner
begins. When should the Coumadin be
started?
A man undergoes a CAT scan of the chest which shows a 1 cm
nodule in the lung. The nodule is
slightly larger than it was 6 months ago.
The patient is a smoker. The
location of the nodule is at high risk for a serious complication if a biopsy
is done. Should the biopsy be done to determine if a
cancer is present? Considering the risk
of the biopsy, should the lesion be watched with a repeat CAT scan done in 3
months to see if it is enlarging or remaining stable?
A patient is seen by a surgeon after a severe attack of
abdominal pain, which resolved. The
patient was immobilized during the pain and was seen in an emergency room where
he was found to have a gallbladder full of gallstones. The
surgeon is not certain that the gallstones were responsible for the pain. The patient is very frightened that if
nothing is done, that the pain might return.
Should the surgeon remove the gallbladder, which might have nothing to
do with the pain, or advise watchful waiting?
Medicine is art and science.
If I’m sick, I’ll skip the scientist.
Give me the artist.
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