2023-10-22 10:00:00
“Uncertainty in medicine,” writes Arnoldo Kraus in #ColaboraciónSpecial.
Uncertainty, in life and in medicine, has two faces: it is a quality when the person stops, asks and wonders. It is a defect when it becomes paralysis or, on the contrary, excessive maneuvering.
I call an “adequate dose” of uncertainty that which invites: inquire, seek advice, doubt and investigate are associated terms. I consider it an inappropriate attitude when it gets in the way or when countless tests are carried out to elucidate the causes of the problem; Although the previous ruling would seem a bit cantinflesca, it is not: there are those who do too many studies due to the uncertainty and there are those who do not act. I will call the previous reflections “excessive dose.”
There are various reasons for uncertainty in the clinic. Some linked to ethical principles, others not. To delve deeper into the causes of uncertainty in medicine, it is necessary to refer to the doctor-patient relationship. If we start from the basis that each relationship is unique, because each patient faces their health and illness according to their principles, their existential values and even their economic possibilities, and that doctors differ from each other for reasons similar to those of the sick, it is possible to conclude that the art of medicine consists of individualization, an art, by the way, in agony today.
I list some ideas, most of them not definitive. They deserve thought and discussion:
1. Most medical schools do not spend time on “medical philosophy.” The value of uncertainty and countless medical/philosophical topics are not discussed in faculties.
2. In our days, where technology has replaced and almost buried the clinic, young students, due to the meager and weak teaching of medical/philosophical problems, consider uncertainty as a manifestation of ignorance, weakness or failure: they are wrong
3. The great British precept, indispensable in medicine, wait and see, allied to the “philosophy of uncertainty”, has no value when the one who decides what should or should not be done is the doctor devoted to technology and not from the clinic.
4. The previous points should be addressed by academic and ethical precepts: students must dialogue with their patients regarding the value of uncertainty and the impossibility of establishing an accurate diagnosis and prognosis “quickly”: waiting is wise.
5. The explosion of medical information in the media tends to corner the doctor. The doctor whose answer is “I don’t know, let’s wait” is frowned upon.
6. When the doctor decides that the patient has only one problem and does not explore the rest of the vicissitudes, he may make a mistake. “Excessive security” is usually to the detriment of the patient.
7. When the doctor hesitates too much – “excessive dose” of uncertainty – he usually requests countless tests and often seeks the participation of several colleagues. Ad hoc medicine should not involve the participation of many doctors.
8. Requesting too many laboratory or cabinet tests to reach a diagnosis is, most of the time, wrong. A poorly interpreted exam is usually the source of new exams to understand the results of the first one. And so on… an endless spiral.
9. The sum of the “excess” uncertainty of doctors and patients is always counterproductive for the latter.
The previous points are an outline of the problem of uncertainty. Some reflections are inconclusive. What is stated here is part of my dose of uncertainty. It is not even a manual at all. In the clinic 1+1 is not always 2.
(Doctor and writer).
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