A physician friend of mine passed on some sage comments by Abigail Zuger, MD.
My young friend had just finished the last months of his medical training. He had faced down many multiple-choice tests and triumphed over them all.
Starting with the S.A.T.s and ending with a series of medical licensing exams, including all the prep courses and practice exams, he probably had tens of thousands of single best answers under his belt. Now they were all burbling up to the surface.He went off to evaluate an older patient with neck pain. It hurt when she turned her head. It had been going on for a few days. “Wouldn’t hurt to get a cardiac work-up,” he reported back. “Stress her, get an echo. Neck pain, you know, tipoff for heart disease. Gotta remember: In old women, heart disease will have unusual symptoms.”
True enough, occasionally. But not in this woman, who had a stiff neck and probably needed a new pillow.He saw a patient whose hips were hurting after a long hike a few days before. “I got an M.R.I., pronto,” he announced. “It could be aseptic necrosis. Bone death. That’s what it usually is with someone taking those drugs.”
No, in fact, even with those drugs, it is usually muscle strain, the kind that hurts a lot and then goes away. Only in the wonderful world of the single best answer should you put your bets on anything more exotic.
He spent a long time with a patient with yet another in a history of headaches. “I vote we put her in for an M.R.I. angio,” he said. “Could be a slow recurrent bleed. Possibly. Gotta rule it out.”
No, gotta not do that. Gotta sit tight and let it be: Reassure the patient, already panicky enough, that all will be well. Put that order form down, get those itchy fingers off the keyboard, and learn that in the real world, the answer to most questions actually turns out to be D, none of the above.
Despite the 2009 Supreme Court decision that said multiple-choice testing was a valid way to evaluate firefighters for promotion, there is a groundswell of voices that say test-taking has little to do with job performance.
In medicine, there is the option to observe first. Take two aspirin and call me. It’s not a cost control solution or some awkward death panel. Rather, it is a physician acting in a way that doesn’t bend to a litigious society. Are we served best by changing the way docs think and/or the medical/legal malpractice laws. My gut says a bit of both.
Dr. Kevin Purcell, DC. Dedicated to serving others …