WORDS OF WISDOM FROM AN OCTOGENERIAN PHYSICIAN

ACCEPTING UNCERTAINTY IS A VERY DIFFICULT MEDICAL SKILL TO MASTER.

“Medicine is an art and attends to the nature and constitution of the patient and has principles of action and reason in each case.”   - Plato.

Recently, I have been thinking about what the most difficult thing for me to deal with, during my forty-year career of practicing medicine. It was, without any doubt, accepting and dealing with uncertainty in medicine.

I believe many factors contribute to uncertainty in medicine, including but not limited to the following:

·       Medicine is not an exact and objective science; it is a combination of various medical sciences and medical arts.

·       There are always too many options and too many unknowns in medicine.

·       Medical knowledge and experiences are ever-changing, and fast accumulating to a level that surpasses human capacity to comprehend and to remember.

·       In the practice of medicine, different personalities, education level, understanding and behavior of doctor and patient are involved which makes practice of medicine more subjective.

·       Every patient responds differently, sometimes adversely to the same medication or treatment.

Because of all these factors, fear of medical malpractice always lingers in every doctor’s mind, despite doing their best.

At the beginning of my medical practice carrier, I felt very uncertain and worried about my medical decisions. I always carried this uneasy feeling home with me, and thought about them continuously, sometimes to a degree that would interfere with sleep.

To make things even worse, patients usually sense this uncertainty in doctors’ mind, and lose the confidence to the doctor.

I observed that not every doctor felt uncertain in their decision making, like I sometimes did. Some clinicians who usually were graying middle-aged doctors practiced medicine with confidence, experience, practical knowledge, wisdom and intellectual humility, always made their decisions so easy, and put their patients at ease with their talk and confident body language. When I asked them how do they do it? They usually would say, -it’s intuitive, it comes to you with experience. Uncertainty is an integral part of medicine; you must learn to live with it.

Like most human beings, my longing for certainty remained unfulfilled for a very long time. I fought with the decision whether to quit practicing medicine altogether or try learning how to live with this feeling of uncertainty.

Then. I remembered reading a Greek mythology book The Myth of Sisyphus. According to the myth, King Sisyphus was condemned by the Gods to push a boulder up to a hill, only to have boulder roll back down to the bottom repeatedly. The King thought since this was his eternal punishment, he might as well teach himself how to enjoy doing it.

Thinking like king Sisyphus uplifted my mood, motivated me to try to teach myself how to deal with medical uncertainties.

I decided to learn more about critical thinking in medicine and apply that thinking to solve medical problems by carefully studying all the clinical case presentations and discussions by experts, in the famed The New England Journal of Medicine (NEJM), instead of just reading medical textbooks, and following medical literature. By doing so, after a long while, I became more comfortable with my medical decision making and the feeling of medical uncertainty.

I further decided to put myself in patients’ place, and not to do anything for the patients that I would not do for myself and force myself always have a plan B for patients in case my plan A does not work.

We live in a complex world. Living is never risk free. We all must take some risks in life, but they must be well thought of and well calculated risks.