Art

I know that I have talked about the art of medicine before.  I have also talked about the lack of certainty that is ever present when practicing medicine.  Endless study and research has gone into removing the uncertainty from medicine, but there is no way to do so completely.  The human body is too complex, too poorly understood, for us to know 100% what the right decision is for every patient. 

It truly is an art.  I will briefly share an experience from a few weeks ago that illustrates this - again, please pardon the vague references, but I want to protect confidentiality.  So, a young woman comes to me with signs of a relatively common problem that is quite serious.  I followed all the scientific evidence to diagnose the condition with laboratory tests - but none confirmed the diagnosis.  Because of her prior history, I referred her to a specialist she'd been seeing so that he and I could get her referred to another specialist ASAP.  They screened her for the same condition I screened her for and did not find any evidence for it.  The other specialist didn't find anything either.  Basically, as a last resort, a risky procedure was done with what seemed like little evidence - and all of her symptoms resolved.  She'd had the condition we were worried about the entire time, but had none of the standard manifestations of the condition. 

I shrugged my shoulders and threw my hands up in the air when I heard that she'd had what we were worried about all along.  She had only one sign, and though the books say that someone with this condition should have laboratory findings to confirm the diagnosis, she did not.  My question was, "How am I supposed to make the right diagnosis and save lives when they don't exhibit the signs they're supposed to?  Don't they read the books?"  I know, of course, that uncertainty is inherent in the job.  That this is an art, and that sometimes I have to follow paths that are not spelled out 100%.  This is why I enjoy the job, but it is also something that makes the job quite frustrating and at times remarkably scary.  All in a days work, I suppose.