A few months ago, when I thought I should throw it all away and go to law school, an acquaintance who is a lawyer said something unexpected. He said “law school is learning how to think like a lawyer and deal with the uncertainty within the law.” Uncertainty? A law is a law right? Don’t speed. Don’t drink and drive. Write thank-you notes. Turns out the law often requires interpretation, especially in complicated cases. Every case is a little different.
Hey! I guess I’m already a lawyer! Because medicine is exactly the same way. The body has some physical laws. The heart must beat. You must eat and drink. The head bone’s connected to the neck bone. When these laws are violated the signs must be interpreted. Every case is a little different.
Recent example: Little old lady comes in to the ER, low hematocrit (loss of blood), difficulty breathing, chest pain. ER doc says, “She’s having an aortic dissection, she needs a CT scan stat!” The cardiologist says, “She’s having a heart attack, she needs an angioplasty stat!” The gastrointestinal doctor says, “She’s bleeding, she needs a colonoscope stat!” The ICU doctor says, “She’s in respiratory failure and needs to be intubated stat!”
Who is right? Maybe a little of one theory combined with a salting of a second theory with a dash of number 3. Doctors don’t just look at you and figure out what’s wrong with you. They analyze the data they have and come up with a few possibilities. They the test these hypotheses with more tests to see which one is right. This lady could have had any of 5 or 6 different things wrong with her. Each doctor that sees her has his own bias based on his training. That’s why the more doctors you have the more confusing things get. This drives you, the patient, nuts.
It used to be you had a family doctor or someone like that who did all the talking and all the diagnosis and you took what he said as the truth and moved on. Not necessarily always the best way, but certainly simple. Now it’s hard to tell who your doctor even is.
So what is a poor patient to do? In the ER this is especially problematic, because really no one is your doctor at first. This is why I must emphasize the importance of identifying the doctor who has the most information and the most broad viewpoint and focus your quests for information on this person. This is most likely the attending physician who will be in charge of your case once you are admitted. The problem is you won’t see this person for hours, and he or she is surrounded by any number of acolytes, so beware. Advocate for yourself or find someone who can. And try not to get frustrated. Medicine is not an exact science.
Shirie Leng is an anesthesiologist who blogs at medicine for real.
