Humility in Medicine

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.

Lowering the blood pressure reading is not the ultimate goal.

The most momentous development in my specialty have 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 the broad range of GI ranging from the liver to the pancreas as well as covering 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 best care that I am capable of delivering. This means carving out areas of my field where I may be unable to meet this standard.

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