Medicine: Science, Art, or Crapshoot?

 

Medicine is complicated, mysterious, and powerful. For many of us who are not medically educated, medicine often appears to be a field of the unknown that resists understanding by the layperson and captures the imagination of those who practice it. Depending on our relationship with medicine, we can be both enamored by its mystery and power, and discouraged by the many questions it raises—in our lives and in the lives of those we love.

But the fact is, I dislike ambiguity. I hate “not knowing,” having to acquiesce to the “wisdom” and education of others. The outcomes can be so confusing and difficult to predict.

Many of you who are on Ricochet know just what I’m talking about. The uncertainty of diagnoses and prognoses; the limitations of a chronic and painful condition; and yet you are determined to gain perspective for the conditions life has dealt you. Especially since it is often medicine itself that has made life tolerable and less painful. Treatments have given you freedom and clarity of what is possible in the future.

Given my health situation at this moment, I really have nothing to complain about. Following a bout with breast cancer and residual peripheral neuropathy, I’m leading a pretty normal life. Except for the polymyalgia rheumatica. When I first brought up my diagnosis on Ricochet, many of you suggested that treatment for PMR can take a while to get consistent results. That is an understatement. Not only am I taking prednisone, which has its own issues (which are mainly annoying rather than debilitating). But my pain can’t “make up its mind” about how much prednisone it is willing to succumb to. So now I’m taking 15 mg one day, 10 mg the next, and have continued that regimen for four weeks. (I began treatment several months ago.) On Friday, I had a blood draw to determine the level of inflammation still in my system. Although I don’t know the “number,” I’m pretty sure it’s going to indicate I’m not in an acceptable normal range. (I expect to get a phone call from the doctor this afternoon.) My body is causing me to reach that conclusion, with my pain dropping in to visit intermittently. I expect the doctor will suggest we continue the current regimen for two or more weeks, and we’ll see how I respond. If that doesn’t work, maybe we’ll try another strategy. The crapshoot goes on.

I sometimes feel as if I’m part of a grand experiment. I know and trust my doctors to provide me with excellent care. I know that maintaining a positive attitude will help me in my daily life. I know that my patience, despite the inconsistency of the results and the healing process, will help me cope.

*     *     *     *

In some ways, I feel that my condition is also an excellent teacher. I have taken my good health for granted. I sometimes lack empathy with the health challenges of others (and I’m not proud of it). My husband has bronchiectasis, a chronic cough, for which there is no treatment. (He brags that he takes no prescription drugs; there are none that will help him.) But the truth is that we are still both active and do our best to stay relatively healthy. I should add that I tend to judge those who don’t take care of their health, who abuse their bodies in one way or another. But I’m learning that we all must make our choices about where to put our focus and how to live lives of integrity and wellness.

I guess for now I’ll stay with the crapshoot.

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  1. Percival Thatcher
    Percival
    @Percival

    God grant that your doctor’s news is good.

    • #1
  2. Susan Quinn Contributor
    Susan Quinn
    @SusanQuinn

    Percival (View Comment):

    God grant that your doctor’s news is good.

    Percival, thanks. I guess that technically there isn’t good or bad news. A goal to reduce the prednisone would be encouraging . . . 

    • #2
  3. WiesbadenJake Coolidge
    WiesbadenJake
    @WiesbadenJake

    This is a fascinating topic, Susan. I remember from my ER days patients presenting with brown grocery sacks of drugs which we would sort through to determine their current medications. We would line them up and it was stunning, at times, to see patients taking drugs that were antagonistic in their interactions. I have been personally very fortunate to have never been on long-term medications except for the last two years, a daily chemo pill. Up until my cancer diagnosis in my early 60’s nurses and physicians were always surprised when I would tell them I was on no medications. The good side of medical research has been the discovery of many helpful drug therapies and I begrudge no one their use if it makes their life better. I wish you the best with the prednisone therapy; I have had short runs of prednisone therapy in the past that proved very helpful.

    • #3
  4. Susan Quinn Contributor
    Susan Quinn
    @SusanQuinn

    I’m trying to sort out the vaccination requirements and recommendations for COVID and flu in FL. This morning I saw a piece on the TV at the gym that was linking flu and COVID shots for kids. (I couldn’t hear the audio.) I can understand why people might want to have their kids get the flu vaccine, since flu can seriously affect children. But Dr. Ladapo here in FL recommended against COVID shots for kids under five. And I think COVID shots for kids is a bad idea. Of course, the CDC has put out its own “recommendations.”

    • #4
  5. Annefy Member
    Annefy
    @Annefy

    WiesbadenJake (View Comment):

    This is a fascinating topic, Susan. I remember from my ER days patients presenting with brown grocery sacks of drugs which we would sort through to determine their current medications. We would line them up and it was stunning, at times, to see patients taking drugs that were antagonistic in their interactions. I have been personally very fortunate to have never been on long-term medications except for the last two years, a daily chemo pill. Up until my cancer diagnosis in my early 60’s nurses and physicians were always surprised when I would tell them I was on no medications. The good side of medical research has been the discovery of many helpful drug therapies and I begrudge no one their use if it makes their life better. I wish you the best with the prednisone therapy; I have had short runs of prednisone therapy in the past that proved very helpful.

    About 10 years ago I had a week of vertigo, and then a hearing follow up. One of the most interesting appointments I’ve ever had. When I repeated to the doc what I had told the nurse that I was on no medications, I thought he was going to kiss me. I was about 53 at the time.

    About 12 years ago I traveled to San Francisco to be with a much younger cousin as she went through a lumpectomy. I was with her as she went over her medications; I swear the nurse had to write “see next page”, the list was so long. There’s a strange relationship that many have with medications.

    • #5
  6. Susan Quinn Contributor
    Susan Quinn
    @SusanQuinn

    Annefy (View Comment):
    There’s a strange relationship that many have with medications.

    I’ve worked very hard at keeping down the number of meds I take. I take a couple of supplements (like a multi-vitamin, calcium and D3), a statin, an SSRI, Osteobiflex (that is supposed to help with bone loss)and one to lower estrogen (that’s supposed to help avert cancer). And now the prednisone. It isn’t that I just hate taking pills, but it seems that they don’t really know for sure what stuff works or not. It’s just irritating, because I don’t want to risk stopping any of it. Sheesh.

    While I was on chemo, Jerry made a chart for me to track which pills I had to take on which days. What a grind.

    • #6
  7. Annefy Member
    Annefy
    @Annefy

    @susanquinn  I’ve had a lot of time to think and observe others in these past 2 + years.

    One thing I’ve noticed is that my peers (woman of a certain age – 60+) with kids have managed better than most. And I think it’s because we went through all the frustrating medical ambiguities and bad advice when our children were small and we were seeing the pediatrician more often that having a date night with our husbands.

    I remember asking our Pediatrician a few questions when son #1 was a baby; I was constantly frustrated by his equivocal answers: You might want to try this … , have you tried this?, … it might be this.

    Then I had daughter. And spent a few years amazed that two babies could be so incredibly different while sharing the same parents. The pediatrician and I had a very good working relationship from then on. I would ask a question, he may or may not give advice. I may or may not take it.

    I’ve been given so much bad advice and wrong information over 20+ years of having children, that now when a doctor is talking my first reaction is skepticism.

    It’s one of the few areas of my life where I am comfortable not knowing. And assuming that no one else does either.

    (typo fixed)

    • #7
  8. Susan Quinn Contributor
    Susan Quinn
    @SusanQuinn

    Annefy (View Comment):
    It’s one of the few areas of my like where I am comfortable not knowing. And assuming that no one else does either.

    Now if you could just package and sell that attitude, I’d be your first customer! ;-) 

    You make an interesting observation about all the medical ambiguity of raising kids. Since I didn’t have kids, I missed that opportunity. I guess I’ll just have to do my best . . . 

    • #8
  9. Annefy Member
    Annefy
    @Annefy

    (duplicate)

    • #9
  10. Stad Coolidge
    Stad
    @Stad

    Susan Quinn: Medicine: Science, Art or Crapshoot?

    All of the above . . .

    • #10
  11. Painter Jean Moderator
    Painter Jean
    @PainterJean

    My late husband’s cardiologist was a brilliant doctor, and I know that the reason my husband lived as long and as well as he did was because of being under the care of that man. He was fond of saying that cardiology was as much art as it was science. I saw that demonstrated very convincingly on those unfortunately very frequent occasions when my husband was admitted to the Mayo hospital and cared for by different cardiology teams. (Mayo cardiologists have a rotating schedule of week-long assignments to the Mayo hospital – as opposed to the Mayo Clinic – so our cardiologist was often not on hospital duty when Dave was in the hospital.) Some teams “got” Dave; some did not. Same patient, same problems, but different outcomes because of the differing approaches of the different cardiologists. It got to the point where our cardiologist would check to see which cardiologist was on hospital service that week, and would sometimes tell us to not waste our time with admitting Dave until a different person was on hospital service. I can remember one cardiologist in particular: I could tell when he first came into Dave’s room that he must have been a cardiologist of some importance, based on how he was treated by the team (great deference and some awe – apparently he had famously helped develop a very important test, the troponin test). He couldn’t figure out Dave at all, never got him stabilized, and I ignored his discharge medication instructions because I knew from long experience that they weren’t going to be helpful. (I was right.) All of this is to say that while we expect medicine to based solely on science, Dave’s cardiologist was correct – there is a great deal of art to it.

    • #11
  12. Susan Quinn Contributor
    Susan Quinn
    @SusanQuinn

    I didn’t hear from the doctor’s office, so I called over. They’ve gotten a new computer system, and some transmissions have fallen through the cracks. Darn. Hopefully I’ll hear from them tomorrow. 

    • #12
  13. Painter Jean Moderator
    Painter Jean
    @PainterJean

    Susan Quinn (View Comment):

    I didn’t hear from the doctor’s office, so I called over. They’ve gotten a new computer system, and some transmissions have fallen through the cracks. Darn. Hopefully I’ll hear from them tomorrow.

    I’m sorry to hear that you have a delay – and that you had to call to find out why, as opposed to them calling you! I hope you do get some practicle, working answers.

    • #13
  14. Susan Quinn Contributor
    Susan Quinn
    @SusanQuinn

    Painter Jean (View Comment):

    Susan Quinn (View Comment):

    I didn’t hear from the doctor’s office, so I called over. They’ve gotten a new computer system, and some transmissions have fallen through the cracks. Darn. Hopefully I’ll hear from them tomorrow.

    I’m sorry to hear that you have a delay – and that you had to call to find out why, as opposed to them calling you! I hope you do get some practicle, working answers.

     

    • #14
  15. Susan Quinn Contributor
    Susan Quinn
    @SusanQuinn

    Painter Jean (View Comment):

    Susan Quinn (View Comment):

    I didn’t hear from the doctor’s office, so I called over. They’ve gotten a new computer system, and some transmissions have fallen through the cracks. Darn. Hopefully I’ll hear from them tomorrow.

    I’m sorry to hear that you have a delay – and that you had to call to find out why, as opposed to them calling you! I hope you do get some practicle, working answers.

    Thanks, Jean. I think they’ve just learned in the last couple of days that some electronics are not coming through, but I don’t think they’ve figured out yet which ones! My hope is that it gets fixed before they have to start either checking on missing transmissions or taking irate phone calls!

    • #15
  16. Stina Member
    Stina
    @CM

    I’ve made it a point to be empowered in the things that affect me and my own on a regular basis. Post flu asthma, seasonal allergies, hyperemesis gravidarum, degenerative corneal abrasions, febrile seizures…

    I want to understand these and get to the bottom of them. I’m not one for giving carte Blanche to a doctor over my health. I need them to diagnose and treat, but if I’m being treated for something, I’m going to dig into it to know as much as I can.

    • #16
  17. Susan Quinn Contributor
    Susan Quinn
    @SusanQuinn

    Stina (View Comment):

    I’ve made it a point to be empowered in the things that affect me and my own on a regular basis. Post flu asthma, seasonal allergies, hyperemesis gravidarum, degenerative corneal abrasions, febrile seizures…

    I want to understand these and get to the bottom of them. I’m not one for giving carte Blanche to a doctor over my health. I need them to diagnose and treat, but if I’m being treated for something, I’m going to dig into it to know as much as I can.

    Some of those sound really difficult to manage, Stina. You take back a lot of power when you do your homework.

    • #17
  18. Jim McConnell Member
    Jim McConnell
    @JimMcConnell

    I rely on my doctors for their knowledge and advice, but always keep in mind that I am responsible for my health decisions. 

    Thanks to the Obamacare Regime, now along with my insurer. As I’ve mentioned before, instead of being the consumer of medical services, we are now simply a commodity in the health industry. We are the means by which our medical practitioners bill the insurance industry for their services. The ultimate medical decision maker, apart from ourselves, is the insurance industry/federal government.

    • #18
  19. Stina Member
    Stina
    @CM

    Susan Quinn (View Comment):

    Stina (View Comment):

    I’ve made it a point to be empowered in the things that affect me and my own on a regular basis. Post flu asthma, seasonal allergies, hyperemesis gravidarum, degenerative corneal abrasions, febrile seizures…

    I want to understand these and get to the bottom of them. I’m not one for giving carte Blanche to a doctor over my health. I need them to diagnose and treat, but if I’m being treated for something, I’m going to dig into it to know as much as I can.

    Some of those sound really difficult to manage, Stina. You take back a lot of power when you do your homework.

    They’d be harder to manage if i had to see a doctor every single time one of these things reared its ugly head. The way the whole thing is set up is that it makes you dependent on them for even simple things.

    • #19
  20. Steven Seward Member
    Steven Seward
    @StevenSeward

    I think part of the frustration with medicine being so ambiguous is that we compare it with the modern world of physics, where everything is either black or white.  Either an engine works or it does not.  A plane either stays in the air or falls down.  There is very little ‘in between” or ambiguity when it comes to the hard sciences.  We have been spectacularly successful with “gadgets.”  Medicine is based on  physical sciences too, but it is exponentially more complex science than fixing a car, or even a space shuttle.

    My wife does research into infectious diseases.  A  lot of her time is spent on testing the efficacy of new drugs.  As far as I know, there are no drugs that work 100% of the time on 100% of the people.  In fact, the variance of effectiveness of drugs in general is extremely wide, ranging from a barely detectable one or two percent effectiveness, to over 90% effective.  My wife gets a lot of results that look only moderately different than random chance, and sometimes no different.  The fact that the U.S. pours a lot of money into developing drugs means that we have lots of resources to develop drugs that are only mildly helpful, and would not have been persued by countries with limited resources.

    • #20
  21. Steven Seward Member
    Steven Seward
    @StevenSeward

    Here’s a minor anecdote of how un-precise medicine can be.

      A couple years ago I kept getting a recurring pain in my ankle while running.   After I would stop and pump my Achilles tendon for several seconds, the pain would go away and return after a few minutes.  It finally got too annoying and curtailed my runs.  One  my best customers is the chairman of orthopedic surgery at a Major hospital system.   I set up an appointment with him to look at my ankle, which was his specialty.

    He manually tested my leg and ankle by twisting and turning it in different directions to find the pain.  He then pronounced that there was a specific tendon that I had slightly pulled or damaged and that stretching it in a certain position would bring it back to full functioning.  I was happy to have discovered the cause, diagnosed by a top doctor who has medical patents to his name.   I followed the stretching program faithfully.  Nothing changed…………….same pain…………..

    A few weeks later it occurred to me as I was siting at my computer (possibly reading Ricochet!) that it was my custom to put my legs up on my computer table for relaxation, with the problem ankle at the bottom.  It often fell asleep due to cutting off the oxygen and I always had to painfully “wake it back up.”  AHA!  So I started putting a pillow underneath my ankle so the hard table did not cut my oxygen flow.  Within a week the pain I had while running stopped, never to return.

    • #21
  22. Susan Quinn Contributor
    Susan Quinn
    @SusanQuinn

    Steven Seward (View Comment):
    A few weeks later it occurred to me as I was siting at my computer (possibly reading Ricochet!) that it was my custom to put my legs up on my computer table for relaxation, with the problem ankle at the bottom.  It often fell asleep due to cutting off the oxygen and I always had to painfully “wake it back up.”  AHA!  So I started putting a pillow underneath my ankle so the hard table did not cut my oxygen flow.  Within a week the pain I had while running stopped, never to return.

    Amazing! Doctor, heal thyself! That’s an intriguing story, Steve.

    • #22
  23. Doctor Robert Member
    Doctor Robert
    @DoctorRobert

    Stad (View Comment):

    Susan Quinn: Medicine: Science, Art or Crapshoot?

    All of the above . . .

    Yes, in roughly equal quantities.  You can have all the Science in the world behind you but fail on insufficient Art.  And vice-versa, of course.

    • #23
  24. Full Size Tabby Member
    Full Size Tabby
    @FullSizeTabby

    Painter Jean (View Comment):
    All of this is to say that while we expect medicine to based solely on science, Dave’s cardiologist was correct – there is a great deal of art to it.

    At least in part because every human being is unique, with unique DNA, and reacts in some unique way to certain inputs.

    I had my experience via my late father about thirty years ago when he got a severe infection in his leg following heart surgery. We went through a fair amount of, “This works for most patients.” Followed by, “Oh, it didn’t work with him, so let’s try this alternative.” One of his specific issues was that most pain medications had a strong sedative effect on him (a mild dose would put him to sleep for 36 hours), which sedative effect was counterproductive for other treatments. Eventually everybody determined that my father had a very high tolerance for pain, and so didn’t need pain medication at all except for some mild local anesthesia when the doctors were actively removing diseased tissue.

    [After the infection was resolved, my father inquired about doing the cardiac exercises he was originally told to do to recover from the original heart surgery. His cardiologist said that since the heart performed fine through the infection and its treatment, the heart was in great shape, and he didn’t need to do the standard exercises to strengthen the heart after surgery. He lived another 23 years until he was 92 years old.]

    • #24
  25. Susan Quinn Contributor
    Susan Quinn
    @SusanQuinn

    Full Size Tabby (View Comment):
    [After the infection was resolved, my father inquired about doing the cardiac exercises he was originally told to do to recover from the original heart surgery.

    He sounds like he was really a fighter, FST. So glad he had so many years after all that!

    • #25
  26. The Great Adventure Coolidge
    The Great Adventure
    @TGA

    No offense to Doc B and other physicians in here, but my trust in the medical profession lies somewhere on the scale between used car salesmen and Congress.  My reasoning is primarily anecdotal, but some of the shenanigans I’ve seen and experienced have been detrimental to health if not downright deadly. 

    I know that one  doc knocked at least 6 months off my father’s life.  He was already suffering emphysema and congestive heart failure and was on oxygen pretty much constantly, so the additional 6 months or more likely would have been miserable, but that’s not the point.

    • #26
  27. Susan Quinn Contributor
    Susan Quinn
    @SusanQuinn

    The Great Adventure (View Comment):

    No offense to Doc B and other physicians in here, but my trust in the medical profession lies somewhere on the scale between used car salesmen and Congress. My reasoning is primarily anecdotal, but some of the shenanigans I’ve seen and experienced have been detrimental to health if not downright deadly.

    I know that one doc knocked at least 6 months off my father’s life. He was already suffering emphysema and congestive heart failure and was on oxygen pretty much constantly, so the additional 6 months or more likely would have been miserable, but that’s not the point.

    I meant to say, even though I hope it was obvious, that my frustration was directed at the practice (maybe that’s partly why they call it a practice!) of medicine and not necessarily the specific practitioners. I’ve been blessed with pretty good doctors; it’s the process that makes me nuts some time.

    I’m sorry about your father, TGA. Sometimes we can only see in retrospect the harm that is being done.

    • #27
  28. Painter Jean Moderator
    Painter Jean
    @PainterJean

    Full Size Tabby (View Comment):

    Painter Jean (View Comment):
    All of this is to say that while we expect medicine to based solely on science, Dave’s cardiologist was correct – there is a great deal of art to it.

    At least in part because every human being is unique, with unique DNA, and reacts in some unique way to certain inputs.

    Absolutely!

    Unfortunately, in my experience egos also play a role. As I noted above, the outcomes of my husband’s frequent hospitalizations varied depending on which cardiologist was on hospital service that week. Many were happy to follow the treatment regimen that had been shown to work before, that Dave’s brilliant cardiologist had worked out, but some were not. I have no doubt that in some cases it may have been fear (the treatment regimen that had been shown to work involved truly alarming amounts of diuretics), but in many cases I think the attending cardiologist had his own opinions and was simply not as receptive to another cardiologist’s opinions.

    • #28
  29. Annefy Member
    Annefy
    @Annefy

    Painter Jean (View Comment):

    Full Size Tabby (View Comment):

    Painter Jean (View Comment):
    All of this is to say that while we expect medicine to based solely on science, Dave’s cardiologist was correct – there is a great deal of art to it.

    At least in part because every human being is unique, with unique DNA, and reacts in some unique way to certain inputs.

    Absolutely!

    Unfortunately, in my experience egos also play a role. As I noted above, the outcomes of my husband’s frequent hospitalizations varied depending on which cardiologist was on hospital services that week. Many were happy to follow the treatment regimen that had been shown to work before, that Dave’s brilliant cardiologist had worked out, but some were not. I have no doubt that in some cases it may have been fear (the treatment regimen that had been shown to work involved truly alarming amounts of diuretics), but in many cases I think the attending cardiologist had his own opinions and was simply not as receptive to another cardiologist’s opinions.

    My late mother had good advice: whatever you do, do not share your suspected diagnosis with your doctor. They will (almost always) reflexively go in another direction. And that was long before google. 

    • #29
  30. Annefy Member
    Annefy
    @Annefy

    I feel badly for those who don’t understand that there’s some art and some crapshoot when dealing with health issues. 

    Last night I was thinking about the people I know who haven’t done so well in the past 2+ years. To a one, they are those who take a doctor’s word (or an institution’s) as 100% science. Maybe they have lived blessed lives where their experience had been 100% positive with the medical community. 

    But I don’t think it’s the whole story. I think they are living lives where they have to remove uncertainty and they think they can do that by following instructions to the letter. 

    There’s one young mom of my acquaintance who treated Covid as a mortal threat to her family (two toddlers). 100% masking 100% of the time. Constant testing. Limited exposure to others. Vaccinations the moment they were available. 

    She’s the only mom I know whose children got Covid and they were legit ill for at least 10 days. Instead of realizing that exposure was inevitable, and that kids get sick, she’s been beating herself up about where she went wrong. 

    • #30
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