Too much medicine: the challenge of finding common ground
BMJ 2015; 350 doi: https://doi.org/10.1136/bmj.h1163 (Published 04 March 2015) Cite this as: BMJ 2015;350:h1163
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Common sense means paying attention to the obvious. This is not as easy as it sounds, because we all have vivid imaginations, and we tend to get lost in our fantasies.
When fantasy replaces common sense, life becomes farcical and even tragic. Life is a series of ordinary events that follow the laws of logic and probability. These ordinary events are indifferent to our fantasies and require the careful, accurate navigation of common sense.
I learned the lesson of common sense as a third-year medical student. I was doing an internal medicine rotation at a VA (Veterans Affairs) hospital, while working with interns, residents, and attending physicians.
One day, on morning rounds, we examined a patient with a black tongue. The intern assigned to that patient had researched all the causes of a black tongue and was eager to demonstrate his new knowledge. As the intern started to lecture us, the attending physician interrupted him and asked the patient if he uses black cough drops. The patient smiled, opened the drawer of his night table, and took out a package of black cough drops.
The intern's face turned red, and we all laughed. The intern was so focused on being a doctor, that he forgot to ask his patient an obvious question. It's been 45 years since I was a third-year medical student, but I still have a vivid memory of that day and that lesson: use common sense, and pay attention to the obvious.
Being a physician has taught me the lesson of common sense again and again. Eventually, I realized that we all lack common sense, and this is why we can't solve our problems. So let's seek common sense and apply it to everything, because knowledge plus common sense is wisdom, but knowledge minus common sense is nonsense.
Competing interests: No competing interests
All over the world whether patients have insurance or not, all of them have a right to get correct cost effective treatment without unnecessary investigation and excessive medication for their better health
Competing interests: No competing interests
Re: Too much medicine: the struggle to undiagnose
The challenge to finding common ground is a particular problem when patients have a diagnosis that once seemed correct to a health professional and the patient but never was or is not anymore. A diagnosis can continue to define patients. Epileptologists and psychiatrists are showing the way by attaching remission to diagnosis of depression and epilepsy, making clear that serious diseases can go away. The study of undiagnosis is still in its infancy but anyone who has tried to convince a patient they never had Parkinson's, Multiple Sclerosis, dementia or stroke (all attempted by the author in the last three years) knows how difficult this is.
Too much medicine is right to focus on overtreatment and diagnosis. Undiagnosis however is an important and neglected part of trying to combat too much medicine.
Coebergh JA, Wren DR, Mumford CJ. “Undiagnosing” neurological disease: how to do it, and when not to. Pract Neurol2014; published online 24 Mar.
Competing interests: No competing interests