How much medical uncertainty can you tolerate? Most patients have not given much thought to this consequential issue, but it hovers over them in their doctors’ offices. This is also an issue for medical professionals. Indeed, how both sides in the doctor-patient relationship navigate this will be instrumental in choosing the path forward.
Medicine is not mathematics. It’s a murky discipline with incomplete data and moving targets. Many of your symptoms – fatigue, abdominal pain, nausea, weakness, sleep disturbances – often cannot be reliably explained. How much testing in such cases is reasonable? I offer no response as this issue needs to be negotiated between the patient and the physician. Since patients and doctors have different philosophies and experiences, there will be several correct and reasonable responses. This is why a second opinion may yield different advice but not necessarily better advice.
An 80-year-old patient who has endured much medical testing may respond, “no mas,” to his doctor, while a younger individual may want a searching diagnostic inquiry. Both patients may be right.
And the threat level of the patient’s symptoms must be considered. For example, if I advise a 50-year-old person with unexplained weight loss, I am likely to assume a more aggressive posture. In this scenario, my tolerance for uncertainty will be low, and the patient is likely to feel similarly. Contrast this with a 20-year-old college student seeing me to evaluate hiccoughs. Since I know no ominous malady lurks, I won’t subject the student to a gastroenterological search and destroy mission. Uncertainty, in this case, can be safely tolerated.
Suppose your medical professional does not feel that your medical issue is a harbinger of a serious condition. How far do you want your doctor to go to try to establish a specific diagnosis? Of course, no medical test is 100 percent accurate or covers all diagnostic possibilities. If you are seeing me for nausea, for example, we could generate a list of hundreds of diagnostic possibilities. Should we try to run through the list over the next year? Probably not.
And, as I alluded to above, when physicians cannot tolerate uncertainty, this can also disturb the equilibrium leading to overdiagnosis and overtreatment. Try to select medical practitioners who share your own philosophy and approach. When the two sides are in sync, your care will proceed more smoothly.
There are times when patients and physicians need to be satisfied that there has been a reasonable diagnostic effort, and the focus should shift to dealing with the symptoms rather than trying to explain them. This can be a tough sell, but I have found that these conversations are time well spent. Even though the doctor may not be able to explain your symptoms, oftentimes, you can still be helped. And isn’t feeling better a worthy objective?
Michael Kirsch is a gastroenterologist who blogs at MD Whistleblower.
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