Skip to main content

Practicing Medicine in the Gray Zone

Many issues have clear and obvious solutions.  Consider some illustrative examples.  If a light bulb has burned out, then most of us would agree that popping in a new bulb should be the enlightened response.  If a flower bed is dry, then we reach for a hose.  If our car’s fuel gauge is nearing empty…   I think you get the point here.

Here's a slightly more complex scenario.  Let’s say that your car has a rattle.  The mechanic may not know the cause or the solution, at least initially, but we can all agree that there is a specific malfunction that can be remediated with a targeted intervention.  As with the dead light bulb example above, there is a specific, reparable defect present. 

Unlike in the automotive world, other disciplines operate with a loose, flexible and proprietary framework.  Consider the financial industry.  One need only read a newspaper’s business section for a week to appreciate the divergence of opinions on financial and investment matters.  Experts cannot agree on the diagnoses or the treatments of sundry economic ailments.  Over the past year or so, for instance, we have seen widely differing explanations of rising inflation and how to combat it.  Of course, political considerations regrettably affect people’s views here, so we may not know what they are really thinking.

If you solicit investment advice from 10 financial experts on where to place funds, you would likely receive a smorgasbord of advice.  Individual stocks?  An annuity?  A managed mutual fund?  Real estate? Tax free municipal bonds?  Or maybe keep as cash for now?   You would be offered an array of financial products with each firm arguing that it would best meet your portfolio’s objectives, after considering market trends, your risk tolerance, age and other factors.   And here’s the confounding part; there is no single correct answer here as there is with a rattle in your car.  Some or even all of the investment firms may be ‘right’.


Everything is not black or white. 


This is the same murky terrain that medical professionals occupy.  Patients’ symptoms are very different from an engine squeak that will disappear after oil is squirted in the right spot.  Consider routine medical symptoms including fatigue, depression, ‘brain fog’, stomach aches, headaches, sleep disturbances, dizziness, nausea or joint pains.  Skilled medical practitioners may disagree on the cause of these stubborn complaints and the preferred path forward.  And similar to the investment industry, various differing medical approaches may be ‘correct’, which can be a vexing reality for patients and their families who have a false sense that there should be a single correct medical response.  Patients who have consulted various physicians for fatigue can corroborate that they have received divergent and conflicting advice.  

If you see 10 gastroenterologists like me with stomach pain, should you expect an unanimous response?  (Hint: answer ‘no’ here.)

When you enter a gray world, don’t expect a black and white solution. 

 

Comments

Popular posts from this blog

Becoming a Part-Time Physician

Next month my schedule will change.  I will henceforth be off on Fridays with my work week truncated to Monday through Thursday.   I am excited to be enjoying a long weekend every weekend.  And while the schedule change is relatively minor, this event does feel like an important career moment for me.  It is the first step on a journey that will ultimately lead beyond my professional career.  It is this recognition that makes this modest schedule modification more significant than one would think it deserves.  As some readers know,   my current employed position has been a dream job for me.   Prior to this, I was in a small private practice, which I loved, but was much more challenging professionally and personally.   My partner and I ran the business.   Working nights, weekends and holidays were routine for decades.   On an on-call night, if I slept  through until morning, I felt as if I had won the lottery.   And w...

When Should Doctors Retire?

I am asked with some regularity whether I am aiming to retire in the near term.  Years ago, I never received such inquiries.  Why now?   Might it be because my coiffure and goatee – although finely-manicured – has long entered the gray area?  Could it be because many other even younger physicians have given up their stethoscopes for lives of leisure? (Hopefully, my inquiring patients are not suspecting me of professional performance lapses!) Interestingly, a nurse in my office recently approached me and asked me sotto voce that she heard I was retiring.    “Interesting,” I remarked.   Since I was unaware of this retirement news, I asked her when would be my last day at work.   I have no idea where this erroneous rumor originated from.   I requested that my nurse-friend contact her flawed intel source and set him or her straight.   Retirement might seem tempting to me as I have so many other interests.   Indeed, reading and ...

A Patient's Loyalty to his Doctor

 A few days before preparing this post, I greeted a patient who was about to undergo her 5 th colonoscopy.  I was the pilot for the 4 prior excursions.   “You should’ve signed up for the rewards program,” I quipped.  “This one would’ve been free!”  Our patients, with rare exceptions, enjoy our light atmosphere seasoned with some humor.  This does not detract from our seriousness of purpose and commitment to their welfare, and they know it.  Our endoscopy team is comprised of outstanding medical professionals. I care for many patients for whom I have performed all of their colonoscopies, which may exceed 10 procedures.   I recently performed an examination on one of my colitis patients who has unique findings which have remained stable for years.   I know his colon as well as I know his face!   Indeed, if I were shown a photo of his colon, I would immediately be able to name the individual.   So, when we gastroenterologists c...