Medical uncertainties can be trying

Sometimes you go to see a health care provider for a problem and the diagnosis or treatment is not straightforward.

You may be asked to have blood drawn or to have a scan of some kind to rule out a particular problem, but your health care provider may also say, “I don’t know.” That can be a difficult thing for someone like me to say, and a frustrating thing for you to hear when you are looking for a solution to pain, fatigue or whatever is bothering you.

Modern medicine has made many advances and we are able to successfully diagnose and treat many diseases, but there are still times when we cannot figure out what is causing illness, have no treatment to offer or cannot guarantee results. It may also be that persistence, repeated tests or a series of examinations are needed before a diagnosis can be accurately made.

Waiting for the results of blood tests or a biopsy can produce anxiety, but the anxiety can be worse when the tests do not show anything wrong. The time waiting and the energy spent to find a diagnosis or an appropriate treatment can be draining.

There is also uncertainty around medications, since they do not always work the same way for all people. Sometimes there is a trial-and-error aspect to prescribing. A particular side effect may be uncommon and there is not a good way to know if it will be a problem for you. It is important to discuss with your health care provider and/or your pharmacist how you will know if the medication is working, possible side effects, other options (including no medication) and a follow up plan to decide if this medication works well for you.

Cancer diagnosis and treatment is one area of uncertainty in medicine. Researchers are looking for ways to detect cancers earlier and more accurately and to find better ways of knowing which treatments will work for which patients.

Recently, controversy around screening for prostate cancer has focused on the risks versus the benefits of using the Prostate Specific Antigen blood test for men who are not at high risk of disease. If the screening test reveals an abnormality, it may be followed by biopsies or other tests. There are increased costs, pain and fear involved and while people are usually glad the tests were done if cancer is diagnosed early and easily treated, the result may also reveal that nothing is really wrong or the cancer is growing so slowly that it is not going to cause significant harm.

When a cancer treatment plan is chosen, there are a number of factors that go into whether that treatment will work. Diet, exercise, stress, genetics and other health problems all affect the outcome. In the future there may be new ways to analyze cells to determine the best treatment, but for now we do not know enough to use such methods accurately.

Uncertainty in medicine is not easy for health care providers or patients to accept, nor should it be. If you have problems that are difficult, it can help to have open communication with your health care team. Persistence can help you to find the answers that are available and work toward ways of coping with or resolving your individual issues.

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