UNCERTAIN?

Yes, I’ve admitted that I didn’t follow my own advice.  I’ve also admitted that not following my advice was stupid.  I’ve got a little more crow to eat.  It seems that, even though I’ve warned literally thousands of patients against it, I’m playing the “would have, could have, should have game.” 

Males usually play, “It is what it is, move on!”  I’ve said that thousands of times yet, in retrospect, find that it’s a form of denial.  The purpose of my review of the past is to look for situations where I could have improved my life, my family’s life and patient care and then teach others how to avoid/react to those situations.

I’ve often said that of all the personal, carefully thought out and studied decisions I’ve ever made, fifty percent turned out to be right and fifty percent were wrong.  I might as well have been a weatherman!  There must have been a better way.

John Allen Paulos said, “Uncertainty is the only certainty there is, and knowing how to live with insecurity is the only security.”  People expect their doctors to be certain about their diagnoses and treatment options.  Children, while challenging their parents, really expect their parents to be certain about their decisions and keep them secure.

Paulos was right.  In the case of medical care, all diagnoses are provisional and as secure as possible given that doctors are human and science is fallible.  Everyone is asking me for my opinion regarding the Covid vaccines.  My provisional advice is based on existing research.  Current data strongly suggests that vaccines for Covid are as safe as other vaccines as far as immediate risks are concerned.  The provisional portion is that we have no idea what future problems might arise over the next 5-10 years.

I’m getting my vaccine on April 7th.  I am secure in the belief that, other than an unforeseen allergic reaction, the vaccine will help prevent my chances of reinfection with Covid at extremely little or no risk.  I am fairly secure that there will be no future problems associated with the vaccine.

The takeaway message for patients is that your doctors are human and therefore, imperfect.  Science is constantly evolving, and therefore imperfect as well. Today’s best medical care will be replaced by tomorrow’s discoveries.

 When we emptied out the old office, I came across my rigid sigmoidoscope (a chrome pipe 60 cm long).  My first thought was that I really couldn’t have put that pipe in patients’ rectums!  Then I remembered that, when I started in medicine, the rigid scope was state of the art and I scoped people by putting them on an inversion table, flipping them on their head and ….. So, listen to your doctor, study your options, and then make the best decision you can.  If you are uncertain as to the veracity of your doc’s advice, get a second opinion from a doctor, not the internet, google or your neighbor.

My advice for docs is to never forget Paulos’ statement, “Uncertainty is the only certainty there is, and knowing how to live with insecurity is the only security.”  As long as you temper your certainty with the possibility that you could be wrong, and the security provided by the title of medical doctor with the insecurity of being human, then in retirement you probably won’t need to play the “would have, could have, should have game.” 

Remember the house call I wrote about previously. The whole family was vomiting and had diarrhea.  They had all eaten the same food.  They all appeared to have the same symptoms.  It was a certainty that they all had food poisoning, wasn’t it?  In fact, it was a trap.  Four out of five members of the family had food poisoning.  The fifth member had an acute appendicitis and I made by that diagnosis at my first visit.  My colleagues, upon learning of my diagnosis, wanted to know how I made that diagnosis when the symptoms and clinical findings were essentially the same as the rest of his family.

One of my mentors had taught me about Paulos and the value of his statement, “Uncertainty is the only certainty there is, and knowing how to live with insecurity is the only security,” creating enough insecurity and uncertainty in me to keep me on high alert.

Mentors are invaluable and the wisdom they shared with me has saved a lot of lives!

Here’s your joke:

A woman goes to the doctors with a piece of lettuce sticking out the top of her underwear.

The doctor says “that looks nasty”, the woman replies “that’s just the tip of the iceberg”

One more: What did the cannibal do after he dumped his girlfriend?

Wiped his butt.

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