The Art of Medicine and the Twilight Zone
The practice of medicine encompasses both art and science.
“Three patients may find themselves in the same situation, …but
may tell three different stories about it… (1).”
The Art of Medicine is exemplified by the above sentence;
focusing initially on the subjective input from the patient before arriving at
an individualized treatment plan, which may stray somewhat from recognized standards
of care.
A consequence, however, was that I often spent some time
each day feeling as if I was in the twilight zone.
The Twilight Zone was a television series, created by
Rod Sterling, that aired years ago. Each episode typically ended with a unique,
often unexpected, twist.
Feeling as if I entered the twilight zone was synonymous
with patient encounters that felt surreal, such as the following:
·
An older male always agreed to a flu shot. He
was sure the vaccine contributed to his health and quality of life. Another
older male always declined a flu shot. He was sure it was a conspiracy by the
medical community to make people ill, to increase the need for medical services.
·
A patient, with acute mechanical lower back pain
after playing tennis, insisted on X-rays and a referral for subspeciality care.
He had an MRI, 18 chiropractic adjustments, and felt improved after 6 weeks.
Another patient, with acute mechanical lower back pain after playing tennis,
adhered to a conservative treatment plan, and felt improved after 6 weeks.
·
An elderly male, happily married, with erectile
dysfunction (ED) trialed a vacuum pump, oral medications, penile injections,
and finally underwent surgery for an implant. Another elderly male, happily
married, declined all possible interventions for ED. He and his wife were “fine
with the way things are.”
·
A patient, with a sore throat “since this
morning,” insisted that antibiotics were necessary. Another patient, with a sore
throat for 7 days, preferred to not take antibiotics unless recommended
·
An elderly male, with severe dementia, remained
at home as his multiple family members worked together to meet all his care needs.
Nursing home placement was never considered. Another elderly male, with mild
dementia, was placed in a nursing home soon after one episode of urinary
incontinence. His multiple family members rarely visited.
·
A teenager had one pimple. He and his mother
insisted on systemic therapy. Another teenager had significant acne. He and his
mother would only accept topical therapy.
·
A patient with metastatic large-cell cancer
declined any treatment or referrals and lived 4 more years. Another patient
with metastatic large-cell cancer requested the most aggressive treatment and
died in 6 months.
·
A female slipped at a store while shopping and
was relieved to know she only had a sprained ankle. Another female slipped at a
store while shopping, had the same diagnosis, and handed me the business card
of the attorney she saw prior to coming for an evaluation. She was planning to
litigate.
·
A women requested to see my office manager to complain
since I was 30-minutes late seeing her. I was giving background information to
emergency medical personnel who were transporting an ill patient to the
hospital by ambulance. Another patient, on the same day, that I saw 1-hour late,
started off by saying, “Gee, I hope the person that just left your office in
the ambulance is okay. You’re really having a busy day…are you doing alright?”
(The Twight Zone theme music was usually heard, in my
head, during such encounters (2).)
The Art of Medicine will always interplay with the science
of medicine, even in this high-tech era.
It should continue to be taught, emphasized and modeled for
healthcare trainees, as all will enter the twilight zone during some of their patient
encounters.
But unless the younger generation watches old Twilight
Zone re-runs (and has the theme music ingrained), surreal encounters are
sure to be associated with something more up to date!
1.
Koven S. The
art of medicine. What’s the story? A guide for the clinician writer. The
Lancet. Volume 393, January 19, 2019: 220-221.
2.
Twilight Zone theme music: Bing Videos
