That is the optimistic version. The pessimistic view is that, when morbidity comes, it hits like a ton of bricks. While morbidity may be compressed in time, medical care then explodes in magnitude, complexity, and, of course, cost. Decision-making requires enormous thought and attention to detail when a patient suffers simultaneously with four or five major illnesses and has a 30 item med list. As medicine gets more and more complicated, doctors and patients can go down blind alleys as they make their choices, never knowing when some disaster will come out of the blue to inflict a terrible blow. Who would have predicted that gadolinium would cause menacing skin fibrosis if the kidneys do not work?
Attending on medicine should teach respect for how complicated patient care has become, especially as people live longer and their bodies fill with myriad drugs. In the next issue, I’ll discuss why consultation and collaboration are important so that confronting complexity does not bewitch us and hurt doctor and patient alike.
Dr. Pisetsky is physician editor of The Rheumatologist and professor of medicine and immunology at Duke University Medical Center.
