“The whole problem with the world is that fools and fanatics are always so certain of themselves, and wiser people so full of doubts.” – Bertrand Russell
The older I get, the more Mr. Russell’s statement makes sense. Certainly, Mr. Russell describes the political climate in our country. My patients have been sending me articles and videos substantiating their beliefs as Trumpers or Anti-Trumpers. Turn on the TV and flip between so called “news” programs and you’ll get different interpretations of the same facts. Of course, CNN will tell you that FOX journalists are fools and fanatics and FOX will tell you the opposite.
Finding the truth is no easy feat. I’m a doctor, not a politician or political commentator so I’ve stayed out of the fray. I guess I am Mr. Russell’s wiser person because I’m full of doubts. So, what does this have to do with yesterday’s article and the art of practicing medicine.
A wise doctor always maintains some level of doubt no matter how certain the medical experts are regarding any issue. At this time, organized medicine will tell you there is no place for hydroxychloroquine in the treatment of Covid. One of my docs is a big fan of hydroxychloroquine. He has treated multiple patients with hydroxychloroquine with good results and has not seen any side effects or adverse effects from its use. My other doc, the one I see in North Carolina, quotes the authorities and refuses to prescribe it. What’s a patient to do? In this case, I chose my NC doc. She is on the ground here and will be my treating doc if I get in trouble. Luckily, Renee and I are recovering nicely.
When your doc is certain, when he/she anchors to a single diagnosis, he/she is probably right. The problem is that, if your doctor doesn’t maintain some level of doubt, he/she has blinders on and is more likely to miss a less common or evident diagnosis. I once saw a family of six for food poisoning. They were miserable. Their youngest son was the most miserable. By keeping an open mind, I was able to diagnose his appendicitis. Five out of six had food poisoning. What are the odds that the sixth would have an appendicitis? Pretty low, but possible.
Your job is to ask a simple question: “Doc, what else could it be?” I’ve written about the “differential diagnosis” in the past; and any time I diagnosed a patient I was always aware of the differential diagnosis (the other less likely causes). Not having a differential diagnosis would be incredibly rare. By asking “what else could it be,” you’ll force your doc to think outside of the box.
Here’s your joke today: Whenever I start doubting my ability to finish all the icing…
… I remember it comes in a CAN, not a CAN’T.