In the medical profession, there is often more than one
correct answer. Present the same case to
10 seasoned medical practitioners and you will likely hear numerous rational plans of action. This scenario would be
bewildering to patients and their families and is one reason that I have warned
patients of the hazards of pursuing a second opinion.
Medicine is not mathematics where there is a single correct
answer that can be proved.
Medicine is not like math.
How does a patient reconcile divergent recommendations
offered by medical professionals?
Should a formal debate competition be held before patients and their families?
How does the medical team reconcile our differing views
amongst ourselves?
Can we expect ordinary patients and their families to decide
if surgery, medication or watchful waiting is the best option?
Despite the current culture of patient autonomy, shouldn’t
it be the physicians’ task to direct patients toward what we believe is their
best option? (I can’t count how many
times patients have told me, “you’re the doctor; just tell me what I should do?”
Should physicians eschew the paternalistic approach
suggested above, and simply present medical options and allow patients to make
their selections in accordance with their own preferences, personality style,
personal treatment goals and cultural and religious beliefs? Shared decision making is today's model.
These are vexing issues for all of us, especially in a
profession where several ‘correct answers’ can coexist. There
have been many times that I have counseled surgery, but the patient declined
this recommendation. Each of us may
have been 'correct'. Perhaps, this
patient is elderly and simply utilizes a medical playbook that is different
from her younger physician. Perhaps, she
endured a terrible complication from surgery performed in the past. Or, perhaps, she wants to try to wait it out,
a strategy that is often successful in the medical world.
The only thing that physicians are 100% certain of is our
uncertainty. Our best advice may be
dead wrong. Conversely, mediocre medical
advice may deliver the desired outcome.
The medical universe is a murky and mysterious entity for those who
visit it seeking answers. Even those of
us who call it home grapple every day with its vagaries.
My advice? Be aware
as you enter the labyrinth that you are no longer in the world of algebra and
geometry. Don’t try to pursue the single
best option, which may not exist.
Choose, with your physician’s help, a path that makes sense for both of
you.
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