When doctors disagree.

Becoming Patient #22

Greetings friends,

One thing that surprised me once I started seeing many different doctors is how often they disagreed with one another. One doctor might recommend an aggressive approach with multiple medications since “time is of the essence”, while another urges caution, advising me to focus on a single issue for an extended period of time. It made me realize that while Western medicine has largely mastered the science of medicine, the art of medicine (the subjective, individualized decisions) remains far less standardized and far more dependent on a doctor’s life experience than their formal training.

I think as kids, most of us think of certain people as infallible. Maybe it’s our parents, public servants like firefighters or police officers, or professionals like lawyers and doctors. I’m now at the age where many of my peers are beginning to occupy these roles, and knowing how far I am from infallible myself, I can presume that my peers aren’t either. For me, it’s pretty easy to accept this when it comes to my local grocery store manager, but it’s a much harder fact to accept that the people in charge of your health are human, capable of making emotional decisions and tragic mistakes. Even when doctors have the same training, the same patient, and the same access to research, they can, and often do, arrive at different conclusions.

I think part of the reason for this, at least in the United States, is how heavily we’ve medicalized health in a scientific and quantitative way. Patients are frequently reduced to lab values, diagnostic codes, and room numbers rather than understood as whole people. While many Eastern medical traditions have serious limitations, systems like Ayurvedic medicine at least attempt to center the individual rather than the population. Randomized clinical trials are invaluable for determining what works on average, but drawing in data without cultivating clinical judgement and nuance risks losing the person behind the disease. The problem isn’t that medicine relies on science—that’s a necessity if we are to make long-term progress—but that science alone isn’t enough to guide care.

Unfortunately, disagreement between doctors puts the patient in a bind, since the responsibility of decision-making falls on the person who is the sickest and the least educated. Recently, for example, I’ve been seeing a specialist who wanted to order several CT scans to evaluate possible vascular issues, but my primary provider (knowing my entire medical history) felt the risks of the scans outweighed the possible benefits. I must have missed the radiology unit in elementary school, because I have very little knowledge to draw on in this instance, and having to be the tie-breaker leaves me exhausted and burdened by the fear of making the “wrong” choice. Patients should absolutely be involved in their own care, but even I don’t want or need complete autonomy over my health.

What I’ve come to realize is that good medicine doesn't mean eliminating disagreement, but rather bearing the weight of uncertainty with the patient rather than handing it off to them. When doctors disagree, what patients need most isn’t absolute certainty, but guidance, context, and a sense that someone is willing to take responsibility alongside them. Science can, and should, inform medical decisions, but it can’t make them on its own. In the future, I hope to shoulder responsibility in the face of disagreement and leave my patients feeling valued, respected, and cared for. Medicine is about treating humans, not numbers, and pretending otherwise only makes illness lonelier.

This week I’d like to know: When doctors disagree, what do you most want from the person treating you?

Well that’s all for this week friends; if you think this would resonate with someone in your life, please pass it along. I’d love for them to join us on this journey.

Stay curious,

Owen