By Michelle Hure, M.D., M.S.
I may not know anything about politics but I know politicians make decisions that affect entire populations of people, for better or worse. As a physician, I can relate to this. My clinical decision-making—and implementation—of that decision will directly affect my patients and all those within their circle. Many people believe it is easy to arrive at a diagnosis and treatment course. Maybe people believe we complete over 12 years of training in order to learn elaborate decision trees to deal with every possible clinical scenario? As if we are a protocol droid following a mindless algorithm. Certainly, some people may believe this who would rather diagnose themselves with Dr. Google. Instead, our grueling and extensive training intentionally teaches us to break down the human body into component parts and understand them completely to troubleshoot and problem solve any disease state. Understand the science behind the normal, you reason through the abnormal.
A physician makes a diagnosis and treatment plan based on different components: observation of outward appearance and function, subjective thoughts from the patient, objective physical exam findings and tests results. All of these components contribute equally to making the most accurate diagnosis and formulating the best treatment plan. Weighting one of the components more than any other, aside from the most obvious diagnosis extremes (chopped off limbs, cancer, and such aside), will get you into trouble. A good physician will look at all the evidence and treat the patient holistically. That means a diagnosis should not rely solely on one thing. A test result, by definition, has bias and can have a varying degree of inaccuracy. If most of the gathered information is pointing to one diagnosis and a study result is saying the opposite, question it. Question all of it. As a mentor told me during a long night in the ICU as an exhausted intern trying to make sense of a test result that didn’t match with my working diagnosis, “Don’t marry the test.” I learned a very critical part of being a good physician. Don’t rely exclusively on a study. Data may be flawed, biased, need to be repeated, or may be just plain incorrect. Make your diagnosis based on the entire holistic picture. Sometimes, even in the face of conflicting data, the best diagnosis and treatment plan comes from the physician’s gut feeling. The gestalt that years of training and experience has taught me has swayed my decision making even in the face of a conflicting test. I have yet to be wrong listening to my seasoned gut.
As a physician, I deal with the life and death ramifications of my decisions and how it affects my patient, their family, their present and future. I look at all aspects that contribute to that diagnosis and make the best choice.
I would hope that the members of our City Council considered all aspects of the proposed In-N-Out as it affects so much of our city present and future. If one study, an inherently flawed traffic study, is solely used to base a decision and future plan despite such a strong community response, we are in trouble. Going forward, take a cue from those of us who look at both data and the big picture equally. Don’t marry the test, question it. Don’t be averse to approaching an issue holistically and using your gut. If it’s good enough for your doctor, maybe it’s good enough for you too.
Dr. Hure is a double board-certified physician practicing medical, surgical & cosmetic dermatology and dermatopathology at her award-winning solo private practice clinic near the Los Rios District, Orange County SkinLab. She is a native Californian and proud to call San Juan Capistrano home, along with her two young daughters and husband.