dPdX >= 1/2 h

Have you ever noticed how going to the doctor usually results in answers such as:

"I think you have..."
"Your symptoms should last about a week..."
"If you don't get better in 3 days, then..."
"We can do this test, or wait..."
"The chances of cure are..."
"I think you have a 50% chance of..."
"Your symptoms could represent...or...or...or...I just don't know"
"This pill may help you with..."



How often do you go to the doctors office and you get an answer such as:

"You will have a stroke in 2 months if you don't..."
"You have only 2 months to live..."
"I am sure you will get ..."
"You will not get a heart attack if you do..."
"This pill will definitely prevent..."
"There is no possible alternative explanation for ..."

While some medical diagnosis and conditions are straight forward and carry with them very high likely hoods, there is a vast array of clinical medicine that is full of a waste land of never ending grey zones. In the world of quantum mechanics, this is called the Heisenberg Uncertainty Principle:

"This uncertainty leads to some strange effects. For example, in a Quantum Mechanical world, I cannot predict where a particle will be with 100 % certainty. I can only speak in terms of probabilities. For example, I can only say that an atom will be at some location with a 99 % probability, and that there will be a 1 % probability it will be somewhere else (in fact, there will be a small but finite probability that it can even be found across the Universe). This is strange.
We do not know if this indeterminism is actually the way the Universe works, because the theory of Quantum Mechanics is probably incomplete. That is, we do not know if the Universe actually behaves in a probabilistic manner (there are many possible paths a particle can follow and the observed path is chosen probabilistically) or if the Universe is deterministic in the sense that I could predict the path a particle will follow with 100 % certainty. "


As much as many would like to have absolutes, 100% certainties, medicine is a vast waste land of uncertainty. It ain't gonna happen. Ever. Just like so much in nature, every new answer we get, leads to a much larger field of unknowns.

The sooner our public, our lawyers, our government accepts that the only certainty in medicine is uncertainty, the better off we will be. Managed expectations should be a priority.

Managed expectations by the patient and family
Managed expectations by the government
Managed expectations by the insurance
Managed expectations by the lawyers
Managed expectations by the doctors.

We are dys-functioning in a system where rationality and the current reality are in congruent. The unsterile and ever changing practice of clinical medicine will always be full of grey zones.

That is why clinical medicine is a merging of the art and the science. Accepting the artistic contribution of the physician education to the treatment of the patient as a whole, not a number or a statistic is necessary to manage the delivery and consumption of health care dollars at every possible point of contact. The patient and the doctor need to decide what each other value most and come to a consensus of action, a plan, based on those mutual values, not based on the values of faceless 3rd party noise.

All the noise bombarding the physician/patient relationship only wants to deal with the science.

When the art is what really matters in the end.