Be obscure clearly.
Muddiness is not merely a disturber of prose, it is also a destroyer of life, of hope: death on the highway caused by a badly worded road sign … think of the tragedies that are rooted in ambiguity, and be clear!
~E.B. White from his classic book on writing well –The Elements of Style
As a family doctor with over forty years of clinical practice under my belt, I have found the E.B. White’s advice for writing can be applied to the field of medicine. I tried my best to clarify the obscurity of the human condition in my job, hoping my patients could provide me the information I needed to make a sound diagnosis and treatment recommendation.
Communication is hard work for many patients, especially when they are depressed and anxious on top of whatever they are experiencing physically. There is still plenty of unknowns in the psychology and physiology of humans. Then, throw in a disease process or two or three to complicate what appears to be “normal” and further consider the side effects and complications of various treatments.
Evidence-based decision making isn’t always perfectly equipped to produce the best and only solution to one individual’s problem.
Sometimes the solution to a patient’s symptom is foggy, muddy, and obscure, not at all pristine and clear. It is the physician’s job to try to bring everything into the best focus possible. Then it is our job to communicate our thinking and decision process in a way that respects the patient’s right to be skeptical.
A physician’s clinical work is challenging on the best of days when everything goes well. We see things we have never seen before, expect the unexpected, learn skills we never thought we’d need to know, and attempt to make the best choice between competing treatment alternatives. Physicians constantly unlearn things we thought were gospel truth, but have just been disproven by the latest, double-blind controlled study, which may soon be reversed by a newer study.
We find ourselves standing on evidence-based quicksand even though our patients trust that we are giving them rock-solid advice based on a foundation of truth learned over years of education and training. Add in medical decision-making that is driven by cultural, political, or financial outcomes, rather than what works best for the individual, and our hoped-for clinical clarity becomes even more obscured.
Forty-two years of doctoring in the midst of the mystery of medicine means learning, unlearning, listening, discerning, explaining, guessing, hoping, and remaining very humble in the face of a disease process or a public health threat like COVID. What works well for one patient may not be appropriate for another despite what the best evidence says or what insurance companies and the government are willing to cover. Each individual we see deserves the clarity of a fresh look and perspective, instead of being treated by cook-book algorithm.
So, as a physician and healer, be obscure clearly.
A life may depend on it.
Make a one-time or recurring donation to support daily Barnstorming posts
Make a monthly donation
Make a yearly donation
Choose an amount
Or enter a custom amount
Your contribution is deeply appreciated.
Your contribution is appreciated.
Your contribution is appreciated.
DonateDonate monthlyDonate yearly
Barnstorming 
Your patients were blessed to have you. ♥
LikeLiked by 1 person
Beautiful, truthful. Just like your splendid heart!
LikeLiked by 1 person
I liked your comments in this Barnstorming devotional. “Be obscure clearly.”
Like most professions, medicine created its own jargon of precise language that would be clearly understood by fellow medical professionals. It isn’t so clear with the majority of people with limited knowledge of the “proper” terms.
If I can recall my experience correctly , the doctor wrote something like this: Multiple near syncopal events due to insufficient cardio-pulmonary regional flow from a dilated left ventricular wall. Ejection fraction using ultrasound measurement is 21%.
Since my undergraduate grades in pre-med studies were too low for admission to medical school, I relied on my wife’s medical degree to translate doctor speak to normal human speech.
In my wife’s family medicine practice, she believed in taking as detailed a medical history as possible including physical traumas that were not treated. Her private practice was cash only because she thought that the time restraints imposed by insurance businesses were too restrictive and would curtail a clear diagnosis and treatment plan.
I supported her through medical school. We were shocked when, in her first year, she was told that a newly minted doctor’s knowledge had a shelf life of 5 years. Hence the need for ongoing accredited medical education (CME) to renew her license to practice medicine.
I attended many of the medical conferences with her to broaden my knowledge base while she earned CMEs. I also voraciously read her medical journals when articles had a personal interest (cardiac, heart failure, renal dysfunction and alpha thalassemia) as well as articles that counted toward CMEs.
She stopped practicing and did not renew her license when the pain from multiple Tarlov cysts along her spine made working impossible.
In the light of human biology and physiology, we are miracles of existence, life breathed into us by the Holy Breath of God and which sustains us one day at a time. For all of this, I am grateful. You gave much in your decades of doctoring. You continue to heal emotional and psychological wounds through your writings, photographs, music videos and your prayerful spirit. I am grateful to you for the constant reminders that life is a gift to be opened with awe and used well each day.
May the Lord’s blessing fill you with joy.
+Michael
LikeLiked by 1 person
Michael, So much here that is absolutely true about doctoring and about being both a patient and a healer. You have far more insight than the average patient because of your wife’s career and your commitment to understand her “language” and knowledge base. I realize every day how much things have changed in the short time I’ve been retired so keep up with educational offerings even though I only use it to share with friends and family, rather than “practicing” medicine any more. It is a moving target, and so true that we must trust God’s design for our aging and failing bodies – we were not meant to live forever! We were meant to live in His Holy Spirit through the blood and body of Christ. That is the best “treatment” I can imagine. Thank you again, Michael, for your wisdom. blessings, Emily
LikeLike
This SO hit home for me. As a retired surgical assistant I am fortunate to be able to decode reports and “doctor speak” for myself and for others. Medicine is an ever changing field and I have always felt that there is not enough mix of East/West approach to diseases/treatments, knowledge of new meds, awareness of non-standard treatments beyond pills or surgery, new procedures. It’s easy to get stuck in the old tried and true and treat each patient the same; to get caught up in “sick care” instead of health care and fix everything with yet another pill. I also feel that there’s not enough attention to what patients tell/feel. They know themselves better than anyone. Being on the side of being the patient now, I often feel horrified by the decline I see everywhere. I recently found myself in the same clothes a day after falling and breaking my leg. No assessment of the rest of me obviously. I could write a book about the subsequent month of hospitalizations and rehab. The “fog” seems to have enveloped the basic education, the acknowledgement of basic human needs, that is the foundation of caregiving. Kudos to you, Doctor. I would crawl through glass to have such a wonderful provider of health care. Thank you for all you’ve done and now continue to do through your stunning photos and thoughtful writings.
Cherie
LikeLiked by 1 person
Cherie, you were immersed in the medical technology world far more than I was, and understand its limitations far better. I hope your healing process is progressing despite the challenges of navigating the “system.” Blessings to you and thank you for your kind words. Emily
LikeLike