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Short pieces on a new theme every month
 
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This month...
  Health Care on the Line
 

Schrödinger's CT

Barry Saver

To be
And not to be...
Indeterminacy
May not be
So bad

Without this scan
We won't know
If you're living
Like the rest of us
Or dying
On a more compressed schedule

Once it's done
You'll be a zero or a one

Are you sure you want to know?

About the poet:

Barry Saver is a family physician, primary-care researcher and teacher at the University of Massachusetts Medical School in Worcester.

About the poem:

"The poem derives from one of the core principles I try to teach students and residents and to use in my own practice: 'Don't ask the question if you don't want to know the answer.' I frequently struggle to get patients and learners to understand the very real harms that can come from testing. At some level, the poem was seeded by my personal experience, as a resident, of being suspended in doubt while awaiting the results of a needle biopsy--wanting to know exactly when the results might be ready, but not being so sure that I wanted them if they were bad. The poem likely also reflects my having spent several years studying chemistry, including quantum mechanics, in graduate school before entering medical school."

Poetry Editors:

Johanna Shapiro and Judy Schaefer

Comments   

# William R. Phillips 2014-08-16 21:55
With a Cheshire smile, this wise practitioner of the Physick, poses a paradox, an entanglement of experimental thought and practical patient care. Thank you.
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# Jacqueline Laing 2014-08-16 19:09
To be able to use so few words to so clearly present this complex issue -- amazing. "Dying on a more compressed schedule" is such an expressive phrase. This is beautiful writing. Thanks, Dr. Saver.
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# Veneta Masson 2014-08-16 10:54
Barry, thanks for the poem and Amen to the succinct message embedded within it. We live with uncertainty--cl inicians, patients, all of us. More information doesn't necessarily yield more answers.
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# Carol Scott-Conner 2014-08-16 09:45
Your delightful poem came after two days of discussion of appropriate follow up of early stage breast cancer patients (how often, routine scans, or not) on an electronic forum. Despite national guidelines, "routine" scans are vastly over-used. Discussion centers around cost and waste, but the impact on the individual patient seems to be lost. The patient should be included in the decision to scan or not to scan. You put the question very cogently - "Are you sure you want to know?" I will post another comment to that site with a link to your poem.
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# Howard Stein 2014-08-15 22:09
Thank you, Dr. Saver, for your rich poem and equally rich comment. You say so much with so few words. I think that part of the issue is "Who needs to know?" The focus or object of your poem is the patient, though the voice is the physician's. Often the physician feels more compelled to know test results than the patient or family. I have heard many a physician, even some family physicians, say: "You've got to know the diagnosis," or "You can't just walk away from a case without knowing the cause of the patient's symptoms." Even if knowing the diagnosis won't make a difference in the treatment,, there remains the urgency to know. For so many physicians, the clinical narrative is incomplete without the "what" and "why" of diagnosis. An indeterminate (quantum) ending to the story becomes unthinkable. Why is not knowing -- John Keats' "negative capability" -- so unacceptable so as to be repugnant?
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# Barry Saver 2014-08-18 12:37
Many thanks, Howard (and others!). Your points about how often providers rather than patients drive testing, diagnosis, and treatment, is important and underappreciate d. E.g., diabetes care remains incredibly glucocentric, despite evidence that, for type 2 diabetes, tight blood sugar control as about the least important thing we can do, as well as potentially harmful. Patients care about HbA1c numbers only because we make them.

Another point that didn't fit here and perhaps requires invoking Heisenberg is how often scans leave us with uncertainty, not certainty. I think radiologists have their board certifications revoked if >10% of their readings do not end with, "Further imaging recommended."
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# Ray 2014-08-15 21:43
I don't always cotton to poetry because I don't understand so much of it, and consequently I feel a bit stupid. But with Barry Saver's poem the meaning, the message, came through right away (and with so few words). Not such an easy thing to do, I suspect.
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