Ignoring the gray areas of medicine
A recent article in the New England Journal of Medicine* lays bare the harsh reality of modern medicine–despite an unrelenting pursuit of medical knowledge in recent decades, gray areas still pervade clinical medicine. Unfortunately, we (both physicians and patients) often ignore these gray areas. Uncertainty is uncomfortable. As physicians, charged with the care of others, we want to have a clear path to providing for the health and well-being of our patients. As patients, we are navigating unfamiliar and complex territory. Cognitively, we need simplified choices with clear consequences. However, such clarity is rare in medicine. Medical decisions carry risks and benefits that exist in probabilistic terms. All too often we ignore this fact and frame choices as dichotomous options. As the authors of this article remind us, we can recognize the inherent uncertainty of medicine and incorporate this into our decision making or allow ourselves to fall prey to overly simplistic conceptualizations of care.
*I highly recommend reading this entire article. It is well-written and has important themes outside of the uncertainty of medicine. I also recommend it because I think it will generate some interesting replies in the coming weeks, since the authors basically called the Society of Breast Imaging and American College of Radiology avaricious blockheads (I’m paraphrasing here).