Yesterday I cited a NY Times essay on the messiness of patient care – It ain’t always pretty

At the time, I knew that I wanted to comment, but struggled, so I delayed.

Later that day I wrote the piece on clinical judgment. Last night as I pondered these two posts, I realized how interrelated they are.

One way to think of the diagnostic process comes from mystery novels. Excellent mystery novels confuse you because the clues are there but buried amongst many “red herrings”. Thinking clearly about which clues are relevant and which clues can be ignored is the challenge for the detective.

The same is true in medicine. As Dr. Zuger describes brilliantly, patient stories are not linear, laboratory data come back in confusing fashion, and imaging studies do not always occur in a timely fashion.

Our documentation rarely reflects the true messiness of patient care. We document to meet financial imperative and to communicate important information.

Messiness defines the challenge of medicine. Performance indicators do not account for messiness.

Our challenge is to live in a world of messiness and yet provide reasonable order. This challenge we relish.