Wednesday, December 5, 2012
We contradict ourselves
Sometimes I trip myself up when talking because I get caught up in the complications. My bias is to see things as irreducibly complex.
There were great scholars of the Talmud who found themselves unable to judge questions of rabbinic law because they could see too many sides. Recognizing that I am not in that league, neither in medical nor in Jewish scholarship, I do feel the same way on many occasions.
"Should I take medication for high blood pressure?"
"It depends."
"On?"
"On your cardiac risk, your tolerance for adverse effects, your potential to lower your blood pressure with diet and exercise."
Now I realize, way too late, why all those jokes about "six months to live" are even funnier (or, perhaps, even less funny) than people realize. Of course the point of those jokes is that the doctor is way too sure of himself (it's always a he in the old jokes). But even deeper, the doctor is wronger than he knows. No one can tell how long anyone else is going to live.
In a recent daily page of Talmud, the rabbis talk about how the books of Ecclesiastes and Proverbs were nearly kicked out of the canon because they were self-contradictory. Somehow, they managed to stay in, but that's never said explicitly, since the reader knows that. Rather, what comes directly after the attempted aspersions on these books is a series of exegeses to make all the contradictory verses work out.
The message for me as a doctor: We are purveyors of narrative in a shifting landscape of multiple truths. To tell a story that works for our patient is being helpful, not deceptive. A story to take our patient through a disease and out the other side is worthy of inclusion in our canon of healing.
Zackary Berger, MD, ACP Member, is a primary care doctor and general internist in the Division of General Internal Medicine at Johns Hopkins. His research interests include doctor-patient communication, bioethics, and systematic reviews. He is also a poet, journalist and translator in Yiddish and English. This post originally appeared at his blog.
Labels: guest post, longevity, patient communication, prevention, risks and benefits, Zackary Berger
posted by Zackary Berger, MD at
11:00 AM
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Albert Fuchs,
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Albert Fuchs, MD, FACP, graduated from the
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Amanda Xi, ACP Medical
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of Medicine, charter class of 2015, in Rochester, Mich., from which
she which chronicles her journey through medical training from day
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Zackary Berger
Zackary Berger, MD, ACP Member, is a primary care doctor and
general internist in the Division of General Internal Medicine at
Johns Hopkins. His research interests include doctor-patient
communication, bioethics, and systematic reviews.
Controversies in Hospital
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Run by three ACP
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db's Medical Rants
Robert M. Centor, MD, FACP, contributes short essays contemplating
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DrDialogue
Juliet K. Mavromatis, MD, FACP, provides a conversation about
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Dr. Mintz' Blog
Matthew Mintz, MD, FACP, has practiced internal medicine for more
than a decade and is an Associate Professor of Medicine at an
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Everything
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Toni Brayer, MD, FACP, blogs about the rapid changes in science,
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FutureDocs
Vineet Arora, MD, FACP, is Associate Program Director for the
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Ryan Madanick, MD, ACP Member, is a gastroenterologist at the
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Richard Just, MD, ACP Member, has 36 years in clinical practice of
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KevinMD
Kevin Pho, MD, ACP Member, offers one of the Web's definitive sites
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MD
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Michael Kirsch, MD, FACP, addresses the joys and challenges of
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Elaine Schattner, MD, FACP, shares her ideas on education, ethics
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Alexander M.
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Reflections of a Grady
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Kimberly Manning, MD, FACP, reflects on the personal side of being
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The Blog of Paul Sufka
Paul Sufka,
MD, ACP Member, is a board certified rheumatologist in St. Paul,
Minn. He was a chief resident in internal medicine with the
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Technology in (Medical)
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Neil Mehta, MBBS, MS, FACP, is interested in use of technology in
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Peter A. Lipson,
MD
Peter A. Lipson, MD, ACP Member, is a practicing internist and
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around in various forms since 2007, offers musings on the
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Janice
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tenens physician. She lives in Idaho when not traveling.
World's Best Site
Daniel Ginsberg, MD,
FACP, is an internal medicine physician who has avidly applied
computers to medicine since 1986, when he first wrote medically
oriented computer programs. He is in practice in Tacoma,
Washington.
Other blogs of note:
American Journal of
Medicine
Also known as the Green Journal, the American Journal of Medicine
publishes original clinical articles of interest to physicians in
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community-based practice.
Clinical
Correlations
A collaborative medical blog started by Neil Shapiro, MD, ACP
Member, associate program director at New York University Medical
Center's internal medicine residency program. Faculty, residents
and students contribute case studies, mystery quizzes, news,
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Interact MD
Michael Benjamin, MD, ACP member, doesn't accept industry money so
he can create an independent, clinician-reviewed space on the
Internet for physicians to report and comment on the medical news
of the day.
PLoS Blog
The Public Library of Science's open access materials include a
blog.
White Coat
Rants
One of the most popular anonymous blogs written by an emergency
room physician.
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