Original post: Feb 25, 2014
It's often tempting to think that there are simple solutions to every problem. The reality is that there are going to be times when finding the right answer is downright difficult (if not near impossible).
As my boys begin their educational career, I can only imagine how many tests and exams they will take over the course of their academic lives. If you counted up the number of bubbles on the multiple choice tests that they will see between MCAS and NAEP and SATs, it might reach into the millions! But on many of those standardized test there is only one "correct" (best) answer. You and I both know that there is often no such analog in the real world.
The field of medicine is even more challenging. I've been reading a number of articles that discuss some of the factors that drive additional costs. There are all kinds of additional tests that are ordered by physicians. In many cases, they are attempting to rule out some very unlikely events.
This blog post titled "
The Real World Is Not an Exam" offers one such example. A young man had just completed his medical training and was attempting to diagnose a patient:
He went off to evaluate an older patient with neck pain. It hurt when she turned her head. It had been going on for a few days. “Wouldn’t hurt to get a cardiac work-up,” he reported back. “Stress her, get an echo. Neck pain, you know, tipoff for heart disease. Gotta remember: In old women, heart disease will have unusual symptoms.”
True enough, occasionally. But not in this woman, who had a stiff neck and probably needed a new pillow.
He saw a patient whose hips were hurting after a long hike a few days before. “I got an M.R.I., pronto,” he announced. “It could be aseptic necrosis. Bone death. That’s what it usually is with someone taking those drugs.”
No, in fact, even with those drugs, it is usually muscle strain, the kind that hurts a lot and then goes away. Only in the wonderful world of the single best answer should you put your bets on anything more exotic.
The author offers a potential solution later in the piece:
They learn to recognize key phrases (neck pain) and stock situations (older woman), and they live in dread of unlikely worst-case scenarios. (Dies from heart attack while buying new pillow. You are sued.) Sometimes the actual, three-dimensional patient is not real enough to eradicate all her paper iterations.
Fear of uncertainty is expensive, and my young friend seemed poised to become single-handedly responsible for the high cost of health care in his ZIP code.
Like all victims of the single best answer syndrome, he ordered tests in wild profusion because, in his experience, every question had an answer and a test that would get you there. Options never included “You decide to keep an eye on it for a little while,” “You tell the patient to come back if it gets worse” or “You must make peace with the fact that you are never going to figure this one out.”
I wonder where the fine line is between caution and fear. It's probably near the line between knowledge and wisdom!
