Moving into the Unknown

Learn to face the unknown is vital to improving doctor-patient interaction.

Idyllwild, CA – July 1, 2016 – by Kasaan Hammon

The “unknown” is an intrinsic aspect to the doctor-patient interaction. The patient has come with questions, and very often fear, of the unknown…”What is going on in my body? How can you help me?” Meanwhile, the doctor faces the unknown diagnosis, as well as the unknown outcome…”What IS going on in your body? How will I treat it? Will the treatment work?” Both sides come into the relationship uncertain and yet desiring to unravel the mystery.

This points to a greater paradox of human nature, in which we are both hardwired to be apprehensive of the unknown, for the sake of self-preservation, and yet undeniably driven by curiosity to explore the unknown. Professor of Communications and Political Science at the University of Delaware Lindsay Hoffman explains, “Humans have always been scared of the unknown. When Christopher Columbus sailed across the ocean, people were frightened he was going to sail right off the end of the earth. There is a stigma of the unknown for the obvious reasons that we are not sure and we do not understand the consequences.”(1) And yet, as paleontologist Maeve Leakey describes, “Exploration seems a human compulsion, a human obsession even.”(2)

The world of medicine is full of the mystery of the unknown, accompanied by equal parts fear and fascination. As Dr. Sushrut Jangi puts it, “There is something intriguing in the medical puzzle, as there is in any good mystery. Collecting clues and dismissing the red herrings, watching the story inexorably unfold.”(3) Dr. Atul Gawande, a former Rhodes scholar and Harvard Medical School graduate, describes his profession as an “enterprise of constantly changing knowledge, uncertain information, fallible individuals, and at the same time lives on the line.”(4)

In this way, doctors are explorers, mystery hunters, and professional problem solvers. The medical chart itself in many ways mirrors the scientific steps of problem-solving: initial hypothesis, historical context, searching for attributes, documenting confirmatory and unsupportive signs, revision, and ultimately conclusion.(5)

A penchant for problem-solving is sometimes considered by med students when choosing a specialty to pursue. When asked which specialty has the most problem-solving in it, critical care and nephrology often top lists. Others are drawn to the wonders of internal medicine and infectious disease, sometimes preferring to pursue these areas in academic versus clinical settings. Some describe radiology as “solving puzzles all day long – you’re looking at images which might show multiple abnormalities and trying to piece them together with the history and test results you’ve been given to come to a diagnosis.”(6) For others, psychiatry may not have the same quick fix in diagnosis and treatment, but it involves unveiling of more long-term mysteries as one explores the human mind.

Dr. Kristan Ahler chose pathology as her outlet for mystery hunting. “I originally thought about neurosurgery, and then once I got to school, I became interested in general surgery,” recalls Ahler, who received her medical degree from Mount Sinai School of Medicine after receiving a Bachelor’s in biology from Brandeis University. “But once I started, I realized that pathology was indeed the best field for me. It’s better suited for my personality because I really like working on puzzles and problem-solving.”(7)

There are some programs designed specifically to explore and solve medical mysteries. The Undiagnosed Diseases Program (UDP), created by the National Institutes of Health in 2008, was created with the mission to provide answers to patients with mysterious conditions that have eluded diagnosis and to advance medical knowledge about both rare and common diseases. The program is a clinical research initiative of the National Human Genome Research Institute (NHGRI), the NIH Clinical Center, and the NIH Office of Rare Diseases Research (ORDR). Instead of a single disease, UDP tackles the hardest-to-diagnose disorders, relying on NIH specialists in endocrinology, immunology, oncology, dermatology, dentistry, cardiology, genetics, and other areas to come up with insights about cases that have often been troubling patients for years.

Nerina Garcia-Arcement, a licensed clinical psychologist and a clinical assistant professor at the NYU School of Medicine, says that “fearing the unknown is something we all experience at some point in life.”(8) For those working in the world of medicine, despite the fear and uncertainty that it involves, this is often eclipsed by the passion to investigate and discover the answers.

Dr. Jangi reveals another importance of exploring the medical mystery, beyond seeking diagnoses. “The medical mystery often hinges on arriving at a diagnosis. But these mysteries, however intriguing, are only the first layer, a facade of the whole story.” Until we ask the broader questions to get a view of a patient’s life, “only then do we truly understand the clues found in the periphery beyond illness, the life into which illness comes. And in that periphery is a far more wondrous mystery than simply solving a case. It is in this periphery where we teach the other what it means to fall ill, to lose faith, to feel stuck, to feel pain, to feel crazy, to grow old, to find grace, to stand up, to forgive yourself, to find peace. And in such an exchange, we open doors, for a moment, into each other’s lives.”

(1) Lindsay Hoffman, “The Fear of the Unkwown,” Huffington Post, June 2015. (2) Stewart Weaver, “What drives humans to explore the unknown?,” University of Rochester Newscenter, February 2015. (3) Dr. Sushrut Jangi, “Questions Doctors Can’t Bill For,” Boston Medical Mysteries, January 2014. (4) Atul Gawande, Complications: A Surgeon’s Notes on an Imperfect Science, Picador, 2003. (5) John Weinman, An Outline of Psychology as Applied to Medicine, Butterworth-Heinemann, October 2013; and MacWhinney, 1973. (6) Student Doctor Network, “Specialties with the most problem solving,” 2007-2012. (7) Joe Morris, “Physician Spotlight: Puzzle Guru,” East Tennessee Medical News, January 2014. (8) Rheyanne Weaver, “Coping While You Wait for Medical Test Results,”, June 2012.

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