After a few decades of medical practice, I am increasingly humbled by how much I do not know. In some ways, I felt more confident just after completing my training in internal medicine and gastroenterology (GI) than I do now. While some aspects of the profession have remained unchanged, such as the value of taking an accurate medical history from patients, other aspects of medicine have morphed into a more expansive and complex landscape. Compared to yesteryear, the array of diagnostic tests and medications has truly exploded.
It has been a great challenge to remain current in my own specialty
of GI, particularly since I am a GI generalist who has seen a very broad range of
digestive conditions. Nowadays, there
are more and more drugs to become familiar with and more complex disease monitoring
and treatment strategies to know. It is incumbent
on those who advocate a new treatment to demonstrate that actual human patients will
benefit. While this may seem axiomatic,
it is not necessarily true. Remember, we
don’t treat elevated blood pressure just to get better readings; we do so to
prevent heart attacks and strokes that real people suffer. A chemotherapy agent might shrink a tumor, which
may sound desirable, but will it make the patient live longer or better? You get the idea.
The most momentous development in my specialty has been the
innovation of futuristic scope devices and techniques that have revolutionized
the field. Advanced GI proceduralists
routinely treat conditions that not long ago would have required surgery. Undoubtedly, real patients are benefiting.
I formerly treated a broad range of GI including the
liver and pancreas as well as spanning the entire alimentary canal, while also performing all of the requisite scope exams that patients know and love. Now,
in the autumn of my career, I have narrowed my medical portfolio concentrating instead on
more quotidian digestive issues. While I
continue to perform solid work, I no longer need medical breadth or complexity
to satisfy me.
I want to assure my patients and myself that I am providing them with the high quality care they deserve. This means carving out areas of my field where I may be unable to meet this standard. It's a lot more important to do everything well than to do everything. Doesn't every patient deserve this?
Editor’s Note: For 16 years, I've published weekly essays here on Blogspot, which will continue. I’ve now begun publishing my work on a new blogging platform, Substack, and I hope you’ll join me there. Please enter your email address at this link to receive my posts directly to your inbox.
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