Tag: clarity

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.