For content related to the science and practice of medicine

Embracing ignorance

Submitted by PeterElias on Fri, 11/08/2013 - 06:00

All day long I work with patients who want answers and certainty. My awareness of how few questions have proven answers, and how unpredictable human health and disease can be, is a heavy burden.  This discordance may be why I enjoyed Stuart Firestein’s excellent book, Ignorance,  so much. He makes an excellent case for the value of ignorance.

The Virgin Mary and the snake

Submitted by PeterElias on Fri, 11/01/2013 - 06:00

I did my family practice residency in a Catholic hospital in the mid west. The strong presence of nuns in leadership and the quiet influence of the attached order and Catholic school lent an unmistakably religious atmosphere to the hospital. Mostly, as residents, we were too busy and too tired to either notice or care, but occasionally the interface between the hospital’s spiritual context and the world of patient care was uncomfortable. Even jarring.


Those other questions...

Submitted by PeterElias on Tue, 10/29/2013 - 06:00

Throughout our medical training we are told again and again that the most important task is an accurate diagnosis. And we hear it at CME lectures and read it in journals. An accurate diagnosis is certainly essential if one wants to offer successful and safe treatment.  But it is not enough to ask and answer: “What is the diagnosis?”

There are several other questions that every experienced clinician asks - and answers - with every visit. Or should ask. We skip these questions at considerable risk to our patients.

When protocols harm patients

Submitted by PeterElias on Tue, 10/22/2013 - 06:00

She called in tears. Beyond tears, actually. She was so upset that it was impossible to get a coherent history and the triage nurse was only able to ascertain that her psychiatrist was no longer willing to prescribe her long-term clonazepam, she couldn’t function, and that she couldn’t afford the urine drug test. She insisted she wasn’t suicidal and didn’t need to go to the ED Crisis Unit, but begged me to prescribe the clonazepam that her psychiatrist had discontinued. With considerable misgivings, I found a way to see her for an extended appointment later that week.