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Adam Cifu, MD's avatar

"Consider becoming a primary care physician in a large hospital system with many quality metrics."

Ouch

Jean-Luc Szpakowski's avatar

I did research in the latter part of my career because there are so many gaps in evidence for why we do what we do. One stands out: my patient with decompensating cirrhosis was found to have a gallbladder polyp now measuring 10 mm. Doing his own research and seeing in the surgical literature that there was a higher risk of cancer, he talked a surgeon into operating, despite my pleas to get followup measurements. After bleeding complications left a scarred-in liver, he later died of the inability to do further surgery. This led to a study of 20 years of Kaiser data, showing overall no higher risk of gall bladder cancer with a polyp than without, and that even with growth to 10 mm cancer was exceedingly rare. So much of what we do is habit, clinical questions led to research: why are we doing colonoscopies-endoscopies on asymptomatic premenopausal women with iron deficiency? Do people with hepatitis C have an increased risk of liver flare when they receive chemotherapy? Is there really a high risk of seeding if one biopsies liver cancers? Do those with hepatitis B die in old age of hepatitis B, or of the usual heart disease-cancer causes?

In medicine as in life, “the unexamined life is not worth living”.

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