This is another fascinating and important interview! How does Courtney manage to find and engage with so many different, inspiring authors? This book is now a must read for Sharron and me!
My problem has been that after treatments for both cancer and heart disease seriously painful results followed and still persist. When I complained to the respective specialists they all explained that this was due to the “law of unexpected consequences.” This is apparently a standard line of defense learned in medical school. Have others encountered this particular phrase? Or Alexandra? I’ll look for it in her book.
Remember to join demonstrations on May 1st wherever you are! It will help the health of both you and the medical system! DD
There are a few different situations I see at play in diagnosis, which I have seen in my family's medical histories and for which I believe there is no one to blame.
One is that there are constellations of symptoms which are consistent with multiple conditions that are really not distinguishable within current medical understanding. I have respected my doctors for sometimes saying we will never completely understand what is going on here (with some particular presentation of symptoms).
A variant of this is how individuals' responses to the same medication or mixtures of medications is not uniform. We are biologically complex in a way that can best be investigated inductively, through trials to determine how things seem to work in this particular case based on what sometimes works in cases that are ostensibly similar but not identical.
I appreciate such honesty as a reminder that medical science does not have everything all figured out. Mystery remains in the world. It often isn't that medical people are not trying hard enough.
Another is the genuinely rare medical condition. One family member has a genetic profile that has appeared only a handful of times in history. Where something is very uncommon, there are simply not the data to support very confident predictions.
I know there are patients whose narratives and questions are discounted because of biases or the pressures on the system. Where I have seen this most is the astonishing amount of time in can take at my HMO to access a specialist, which comes sometimes because of first-come-first-served systems in place of maybe more sensible triage. Like one might hope checks for skin cancer in people with significant history of skin cancer might rightfully take scheduling precedence over cosmetic dermatology.
Very wise as always, thank you. Alexandra's book talks about much of this, including the genuinely rare medical condition. It truly is a fascinating, wide-ranging read.
There’s clearly a lot to unpack around the issues at play for patients and doctors. But I’d just like to say that I so appreciate the nuanced way that the healthcare system was discussed here. Often, I read pieces that blame doctors without taking a step back to recognize the systemic factors that put pressure on us (and every other person who works in healthcare). For myself, the farther I’ve gone in my career, the more I’ve realized how much I don’t know, how important it is to recognize my biases, and the importance of believing patients (or their parents) as they tell you their experience. And that’s what I try to pass on to those who I train.
And that's why you're probably an amazing doc! I was just talking with a friend who works in healthcare about standing in the tragic gap of the way it is designed big picture while, each day, trying to do right by the people you work with and for. Such a hard dance.
Thanks, Courtney! Some days it truly feels like trying to bail out a sinking ship with a bucket full of holes. And yet I can’t imagine a greater privilege than the work I get to do in the pediatric ICU.
This made me want to gently place the entire healthcare system in a chair and ask, “So… what would you say you actually do here?”
The part about diagnosis being closer to car repair than some pristine temple of certainty really got me. Because yes. Sometimes the body is less “textbook case study” and more “mysterious dashboard light that only turns on when you’re finally five minutes from home.”
I also love the emphasis on humility. Give me the doctor who can say, “I don’t know yet, but I’m going to stay curious,” over the one cosplay-performing omniscience in a white coat. Especially for people who have lived in the weird medical purgatory of “your tests are normal” while their body is very much running a haunted escape room.
More intellectual streaking, please. Fewer god complexes with scheduling portals.
This is another fascinating and important interview! How does Courtney manage to find and engage with so many different, inspiring authors? This book is now a must read for Sharron and me!
My problem has been that after treatments for both cancer and heart disease seriously painful results followed and still persist. When I complained to the respective specialists they all explained that this was due to the “law of unexpected consequences.” This is apparently a standard line of defense learned in medical school. Have others encountered this particular phrase? Or Alexandra? I’ll look for it in her book.
Remember to join demonstrations on May 1st wherever you are! It will help the health of both you and the medical system! DD
Fascinating! I would love to know if Alexandra heard that come up in her reporting.
There are a few different situations I see at play in diagnosis, which I have seen in my family's medical histories and for which I believe there is no one to blame.
One is that there are constellations of symptoms which are consistent with multiple conditions that are really not distinguishable within current medical understanding. I have respected my doctors for sometimes saying we will never completely understand what is going on here (with some particular presentation of symptoms).
A variant of this is how individuals' responses to the same medication or mixtures of medications is not uniform. We are biologically complex in a way that can best be investigated inductively, through trials to determine how things seem to work in this particular case based on what sometimes works in cases that are ostensibly similar but not identical.
I appreciate such honesty as a reminder that medical science does not have everything all figured out. Mystery remains in the world. It often isn't that medical people are not trying hard enough.
Another is the genuinely rare medical condition. One family member has a genetic profile that has appeared only a handful of times in history. Where something is very uncommon, there are simply not the data to support very confident predictions.
I know there are patients whose narratives and questions are discounted because of biases or the pressures on the system. Where I have seen this most is the astonishing amount of time in can take at my HMO to access a specialist, which comes sometimes because of first-come-first-served systems in place of maybe more sensible triage. Like one might hope checks for skin cancer in people with significant history of skin cancer might rightfully take scheduling precedence over cosmetic dermatology.
Very wise as always, thank you. Alexandra's book talks about much of this, including the genuinely rare medical condition. It truly is a fascinating, wide-ranging read.
There’s clearly a lot to unpack around the issues at play for patients and doctors. But I’d just like to say that I so appreciate the nuanced way that the healthcare system was discussed here. Often, I read pieces that blame doctors without taking a step back to recognize the systemic factors that put pressure on us (and every other person who works in healthcare). For myself, the farther I’ve gone in my career, the more I’ve realized how much I don’t know, how important it is to recognize my biases, and the importance of believing patients (or their parents) as they tell you their experience. And that’s what I try to pass on to those who I train.
And that's why you're probably an amazing doc! I was just talking with a friend who works in healthcare about standing in the tragic gap of the way it is designed big picture while, each day, trying to do right by the people you work with and for. Such a hard dance.
Thanks, Courtney! Some days it truly feels like trying to bail out a sinking ship with a bucket full of holes. And yet I can’t imagine a greater privilege than the work I get to do in the pediatric ICU.
This made me want to gently place the entire healthcare system in a chair and ask, “So… what would you say you actually do here?”
The part about diagnosis being closer to car repair than some pristine temple of certainty really got me. Because yes. Sometimes the body is less “textbook case study” and more “mysterious dashboard light that only turns on when you’re finally five minutes from home.”
I also love the emphasis on humility. Give me the doctor who can say, “I don’t know yet, but I’m going to stay curious,” over the one cosplay-performing omniscience in a white coat. Especially for people who have lived in the weird medical purgatory of “your tests are normal” while their body is very much running a haunted escape room.
More intellectual streaking, please. Fewer god complexes with scheduling portals.
Perfectly put. I love this comment.
This is so thoughtful! Thank you ❤️
Thank you so much. Means a lot coming from you. I loved your conversation with Jessica Slice.
❤️