Don't become a doctor #14 - Uncertainty

The first time anyone told me that something was unknowable was in science class when I learned about the Heisenberg Uncertainty Principle. You cannot know the exact momentum and position of an electron at the same time.

Well, surely, with better tools and more precise ways of measuring... "No, no, no, you don't get it!" My p-chem professor had crazy, uncombed hair and he had missed a button on his shirt. All the buttons were off, so it was hard to take his words seriously. "A thousand years in the future, with the best tools available, we will never know."

Medicine is not without its own uncertainty. And that doesn't sound so bad in an academic sense, but it's not very comforting to patients. How do you tell a patient that you don't know? I don't know what's causing your abdominal pain. I don't know if it's from your heart or if it's acid reflux. I don't know.

As a practicing physician, I've gotten used to it. The students seem to have a much harder time with it. As a resident, I worked with a group of students, and uncertainty was a problem...


"So, is it Buerger's Disease?"
"Excuse me?"
"The case from this week, Buerger's Disease, right?"
"Oh, the case. There's no answer. It's just an exercise."
"But we were supposed to think about Buerger's Disease."
"It's in the differential, but there are lots of possibilities."
"But it's really Buerger's."
"Well, there's no answer."
"How can there be no answer? It's Buerger's Disease!"

In medicine, there are lots of questions where we never get any answers: poorly differentiated tumors, diseases without any diagnostic tests, all sorts of situations without clarity. Sometimes we spend time and energy to try to find the answer. Sometimes we don't even bother. But the truth is that in medicine, there is uncertainty on all sides.

4 comments:

Anonymous said...

Hi,

a lurker from two years ago when I was considering med school... Ended up in b-school, but still continuing to wonder if I should try medicine. Anyway, enough about me - just wanted to say that blogs like yours are helpful; it's nice that you've continued to write. Happy 2009

-K

JJ said...

Hi Dr. Ifinding,

I should really be studying for my surgery shelf but because I cope with stress by procrastinating, I've been reading your blog instead.

Just wanted to thank you for your DBAD series even though you received quite a bit of flack for it initially. From what I've seen in my fellow MSIII peers, your series is sorely needed.

Ever since I took the MCAT several years ago down to the day before I started my third year of medical school, I often reassessed my motivations behind going into medicine. I used to volunteer at a VA hospital where I met a resident who tried to discourage me from my decision: "It's not what you think it's going to be," he bitterly said to me. I remember reading NEJM's article on medical school depression when I was interviewing at medical schools. And I also came across your DBAD series during my first couple of years of medical school.

When I first started medical school, I still felt tentative about the path ahead of me. I remember envying my classmates' bright-eyed idealism and excitement. Now, halfway through being an MSIII, I have seen some of those same classmates lose that shiny naivete to have it replaced by a bitter burnout not unlike that of the VA resident.

I realize now that I've been lucky to have been "warned" about the pitfalls of medicine because rather than becoming disillusioned during my 3rd year, I can concentrate more on the pleasantly surprising and gratifying (e.g. seeing a mother hold her child for the first time). Sure, I'll probably become more jaded and burned out when I'm a resident, but at least I haven't been surprised by the ridiculously long hours or other realities of being a doctor.

I know that you write this blog for yourself, but reading about your clinical experiences and insights has been engrossing and even therapeutic. It's nice being able to connect to someone else's thoughts on something that consumes >90% of my life.

To put it succinctly, thanks!

Metapodiac said...

There may be uncertainties at first, it's kind of like detective work because at first you start off with all these possible suspects and then you do tests to narrow down the possibilities, for example it might be 90% chance of disease A 10% chance of disease B and then you do a test such as a tissue sample or urinalysis etc to eliminate the possiblities

incidental findings said...

My point is that the best detective work may still be fruitless, and the cause remains a mystery. We search for answers but don't always find them.