Guest post by Aaron Schenone MS IV
As medical students, future residents and physicians we’re used to the statistics. Whether it’s to assess for appropriate screening tools, treatments, or patient outcomes, we have experienced the positive impact evidence based practice has and will continue to have in medicine. But are statistics an absolute in patient care, and if so what are we in jeopardy of leaving behind?
As we move forward in a world with greater chronic disease prevalence, diminishing medical resources, and a financial reimbursement system incentivized by statistical outcomes, do patients always benefit? Of course many statistics provide reassurance. A patient with stage one colon cancer may find some solace in their statistical prognosis, but how should we use statistics with more advanced diseases? After all, even after confronted with bad news, how many patients are still secretly awaiting a medical miracle?
Dilemmas are something we’re used to in medicine. As soon as we open the door we prepare for the battle between costs, outcomes, and the needs of our patients. In many cases these responsibilities are fairly congruent, but how do we approach when they’re not?
On night call I met an 85 year old man sitting in his chair gasping for breath. He had just had an unstrangulated hernia repair indicated for his refractory pain. However he also heart, liver, and renal disease. He was lucky to have made it off the table and when confronted with these statistics, he wanted to operate. The pain was just too severe. That night we identified ruptured esophageal varices, and pulled more than a liter of frank blood from his stomach. He was intubated, stabilized and passed the next day.
Weighing our responsibilities to patient needs, while refraining from harming them, is absolutely tantamount to medical practice. However, all too often we find ourselves weighing those responsibilities against our inherent desire to ease suffering. Until statistics create a crystal ball, we will need to enter the patient’s room ready to comfort always, cure sometimes, and weigh our abilities to ease suffering against the potential risks of our care.
About: Aaron Schenone MS IV is presently a fourth year medical student applying to internal medicine residency. He is a consultant with a Biotech Company Histogen Inc. where he applies Oncologic, Biocompatibility, Regenerative Medicine, and Tissue Engineering. He is a Siteman Cancer Summer Scholar Recipient, and have continued with the institute investigating both clinical and basic projects within soft tissue sarcomas. He was also the President of the Dermatology and Oncology Clubs in 2012 and finished Ironman New Zealand in 2002 before starting this whole medical adventure.