Daniel Crook, @EMSafe dropped this in twitter a couple of weeks back:

I realise that I have had to learn and do medicine in 7 different ways:

What the book says

What we actually do

What the course says

What the College/exam wants

What the boss wants

What the evidence says

What other people will do who don’t know the evidence

I’ll add this one:

What to do when the clinical picture isn’t clear.

Physicians often work in situations that are poorly defined. Even with our best efforts at defining a situation, the key elements aren’t always there like in the studies.

Despite the world portrayed in text books and consensus opinions, many of us operate in a zone of medical uncertainty. We do the best we can with the evidence we’ve got and the patient before us.

Medicine’s march toward precision has clinical care looking cleaner than ever before. But humans remain messy, imperfect, emergent organisms. That goes for doctors and patients.

I heard recently that the difference between a palm reader and a physician is evidence. I can’t disagree. Of course, evidence can only impact care when it fits the studied circumstances.

Sometimes we still have to ask to see the patient’s hands.