On Fighting

We had PBL (problem based learning) and this session to me makes us feel most like a doctor (apart from CST). It's where we are given a case, with clues and we have a discussion with our group and diagnose the patient with the signs and symptoms that we have.

The facilitator of our PBL, at the end of the discussion, (on a completely different note) told us that being a doctor, it is extremely important to look closely (she said it slightly differently but I can't exactly recall now). For example there was a case she faced whereby a surgeon cut out the colon of a patient because the patient had abnormal bleeding in his lower abdomen which did not seem to stop. Only after the operation did they find out that there were worms in the intestines which would have been easily treated with antibiotics... and there was actually no need for the surgery.

In relation, I was reading a back called "Better: a surgeon's notes on performance" by Atul Gawande, and one of the chapters I flipped to was "on fighting".

It was essentially about; how far would a doctor go? How far SHOULD a doctor keep pushing? When pushing can mean detrimental effects. But not pushing can mean lack of commitment. In the above case, the surgeon may have been trying so hard and in his effort, felt that removing the intestines was the best course of action.

When you keep pushing, it means you're not giving up and you want to find a cure to the patient, does it not? It did spark some curiosity in me. Ethical questions; which ultimately have no concrete, statistical answers to. The solution is found with the heart. And more importantly, as many forget, the solution should be guided by Allah.

I like how the writer put it:

In the end, no guidelines can tell us what we have power over and what we don't. In the face of uncertainty, wisdom is to err on the side of pushing, to not give up. But you have to be ready to recognize when pushing is only ego, only weakness. You have to be ready to recognize when the pushing can turn to harm.

In a way, our task is to "Always Fight." But our fight is not always to do more. It is to do right by our patients, even though what is right is not always clear.

In the end, it's always for the patient's best interest at heart, is it not?

Personal reminder for those clinical years.