Blog | 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 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.