Medicine: Art and Science

One day, I examined a patient who came to the office complaining about a "cold" and found a breast lump which another doctor had not found earlier that day. I visited her in the hospital, following her cancer surgery,  and she asked me "after all, I only came in for a cold; why did you find the cancer that Dr. ***** couldn't find?"  I gave her the best answer I knew:  we all recognize in looking at a work of art that some of us see things that others don't; similarly, each well-trained and skilled physician may recognize something significant in an examination that the next physician may not appreciate.

I thought about my answer recently as I went from physician to physician seeking a diagnosis and appropriate treatment for my own painful condition. One doctor found the answer to one issue, but missed others; the second had a list of differential diagnoses pertinent to his own field, and when my diagnosis did not match his list, I knew it was time to move on; the third doctor put two and two together and came up with four, but the answer was really five, as I learned today from the next doctor in my tour of specialists in the Bay Area. Fortunately, "5" is benign and treatable.

The message to my readers is that medicine is a blend of art and science. The scope of knowledge and experience required for the diagnosis and treatment for a complex patient may go beyond what we can reasonably expect of a single physician or single system. Patients must some times be willing to put aside their confidence and implicit trust in their physicians or health systems to seek more complete and appropriate answers elsewhere. It isn't that their physicians or health systems are incompetent: it is that they represent humans who are limited in their capacities to solve all problems, even when they practice within the standards of their professions. Sometimes a second or third opinion is needed. Sometimes two plus two equals five.