Editor's Commentary on 'Obituary Blues'

 , October 17, 2014

Listen to commentary here 

As the increasing popularity of buzzwords such as “evidence-based medicine” and “value-based care” demonstrate, our profession emphasizes the use of a scientific approach to learning medicine and caring for patients. Yet sometimes, our information (or inspiration) can come from unlikely sources. Such is the case in Dr. Clayton Baker’s “Obituary Blues,” in which a perusal of the daily obits sets in motion an effort to locate one of Baker’s patients. This process, in turn, helps Baker to learn of his patient’s recent hospitalization and tenuous health.

Throughout the search for Willie Brown, as we work through the various questions that arise in the “case,” the issue of uncertainty surfaces repeatedly; this is perhaps most prominent at the end of the piece with the author’s statement that he has “come to accept that in [his] practice, something well beyond [his] understanding happens at least once a day.” While being able to deliver a diagnosis with certainty or make a recommendation based on high quality evidence is comforting and reassuring, this is often not the reality we face. Rather, we work, as Robert Lowes puts it, “in the fog of medicine, where the only certainty is uncertainty.¹” Learning how to function – or even thrive – in this fog can be a daily struggle. Baker’s piece reminds us that not everything is medicine is knowable; nor can we reasonably spend time searching for answers to every possible question that arises. We need to embrace the uncertainty with the science to become the best physicians that we can be.

Rachel Elkin

1. Lowes R. Coping with clinical uncertainty. Medical Economics. 2003; 80(20): 53-54.