In a world of so very many uncertainties, of unexpected rainy days and devastating tornadoes, it comes as no surprise that human beings crave guarantees whenever possible. We advertise them with everything from new cars to roofs on our homes, and we relish the comfort they provide, deserved or not.
This desire to know something for certain is particularly evident in medicine. Not a week goes by that a patient doesn’t come into my office with a new problem, whether it be headaches, visual changes, cough, abdominal pain, or a sore back. While they are there mostly to have me begin the work-up to ascertain the source, a significant reason for their visit is reassurance, not just that we will be able to offer some comfort for their malady, but perhaps more important, that the source of their complaint is not something truly devastating, such as cancer.
I will lay out my thoughts on what is going on, describe our plan for working things up, and ask for questions, and so often the reply is, “That’s great, Doc, just as long as this isn’t going to kill me!”
The overwhelming majority of the time, it won’t. But I rarely give such guarantees, because medicine is, like life, not an exercise in absolutes. It is instead a practice in possibilities, where we depend upon the scientific process and large-scale studies to identify what symptoms are most likely to indicate a certain disease process, and which medications or interventions are most likely to successfully treat said processes.
Yet, as any Google search will tell you, these are not foolproof endeavors. Statistics saying that there is only a 1 in 100 chance of a serious side effect are only reassuring until you are the 1 out of that 100.
Almost always, is a straightforward complaint without any “red flag” symptoms simply allergies, or a muscle strain, or a quirk of aging?
However, there is always that small opportunity for rainy days and tornadoes, in medicine as in everything else, so I will always do my best to explain to patients that nothing is absolute. It’s not the guarantee they’re looking for, but if I’m doing my job correctly, this is information delivered in a calm, compassionate, and reassuring fashion, and they leave my office knowing that the likelihood of calamity is low, but that even if the tornado strikes, I’ll be there with them, working through the storm.
This fundamental aspect of the universe is particularly on my mind this week with regard to the Covid-19 pandemic. Last week, the State of New York lifted the travel restrictions that have required people coming from noncontiguous states and other countries to obtain a negative Covid-19 test and quarantine for a period of time upon arrival to New York. This move, coupled with constant, much-needed news of rising vaccination rates throughout the country, seems to have left many with the near-absolute feeling that the pandemic is on the veritable verge of being over and done.
And yet the Covid-19 case numbers are rising here in the United States once more. Granted, the percent increase is less than the dramatic jumps we saw last spring, summer, and after the Christmas and New Year’s season. Less is good, of course, and reassuring, and no small part of that is due to a robust immunization program that sees more than 4 million people being vaccinated daily.
But if you’re asking yourself why your doctor is still adamant about mask wearing and social distancing, about why there is such an urgency for vaccination when overall case numbers remain much lower compared to the worst spots of this pandemic, it is because we remember that there are no certainties in medicine. Just because we have fought so hard and come so far and so many are now vaccinated does not mean we are out of the woods yet.
Is this an uncomfortable thought, just as it is when I tell a patient that I cannot 100 percent guarantee their complaint is not cancerous in origin? Of course. In life, as in medicine, there are no absolutes.
All we can do is our very best to reduce as much as possible the likelihoods of terrible outcomes. In the case of Covid-19, that means not completely relaxing our vigilance against infection and transmission in the effort to see this pandemic through to its true end.