Page 13 - 2019EthicBk

Uncertainty feels grander in medicine because human lives
are at risk. In the chapter “The Case of The Red Leg,”
Gawande wrote about a young woman who was initially
diagnosed with lower limb cellulitis but eventually turned out
to be necrotizing fasciitis. She no longer had fever after the
administration of systemic antibiotics, but the erythema and
induration kept progressing rapidly over the affected lower
limb. Gawande intuitively thought something was wrong and
persuaded the patient’s family to proceed with the biopsy.
Doctors come across lots of uncertainty and gray areas in daily
practice and sometimes rely on their intuition based on
previous clinical experience to make decisions. In many
occasions there are simply no evidence-based guidelines to
help us with decision-making. That’s why doctors often depend
on intuitions. Decision-making may be surprisingly
unconscious activity. I noticed the very same phenomenon in
my personal experience, verifying how amazingly accurate
some of those intuitions could be, especially in patients with
impending respiratory failure and would soon need intubation
as “predicted” by some senior residents or attendings.

對醫學、社會方面影響：

The chapter “When Good Doctors Go Bad” discusses
about “problem doctors.” There are four types of behavioral

2019 年•醫學倫理•人文醫學•心得 3