Wednesday, September 2, 2015


      In physics we have uncertainty principle. In that situation we 'don't know' the out come till the event occurs.But I think in medicine also we have the same . But why talk about the medicine , we face it in every walk of the life . We appear in an examination ,and we 'don't know' if we passed or failed till the result of the examination is declared. So there is uncertainty. If we apply for a job and have an interview, we don't know if we got the job or not till we get the letter.So the uncertainty principle goes apply in every place . But we don't realise this as the 'out come' is predicted and some of the predictions are as close to 100% as possible .So there is no uncertainty in say some one smart and studious takes the examination. we know he is going to pass. So we don't think there is any 'uncertainty' in him or her passing the examination. That brings me to the medical uncertainty.
     I saw this 73 years old male patient, who was referred to me for abnormal chest X-ray. He was a nonsmoker and had no major complaints . But he had read 'somewhere' that one should get chest X-ray. So he had chest X-ray done . It was abnormal and so the primary care physician ordered the CT scan . The CT scan was abnormal and showed a lung mass. So he was referred to me . He came with his wife . So I saw the CT scan and showed him the pictures and showed him the mass. I told him that topically this kind of mass  in all probability will turn out to be i usually tell patient that we need to answer 3 questions. 1 Is it cancer ,2 Has it spread and lastly 3 What is the treatment opiton . So I explained them the need to do the work up To get the diagnosis I suggested the Bronchoscopy and if needed needle biopsy or Open biopsy to resect it out , if it is resectable and has not spread. So I told them that we will do the PET scan to see if it has spread. (In PET scan we inject glucose tagged with nuclear material . The glucose is picked by every cell in the body . The metabolic activity of the CANCER cell is higher than the normal cells , so they pick up glucose more avidly. So the scanner measures the activity and one can 'predict ' the chance of the mass being cancer ) .We did the PET scan  and the breathing test. His PET scan was positive , suggesting that the mass was cancerous. and the breathing test was showing 'adequate ' reserve for the resection of the mass . He did not want any biopsy . So I sent him to a surgeon for consideration of surgery . He saw 2 different surgeons and both told him and his wife that he needs to have surgery and the lung resected. He and his wife were convinced that this mass was a fungus or 'mold' and we were all wrong . The pharmaceutical companies have corrupted the system and we were brained washed and he did not believe that he had cancer as he had no symptoms. He also had number of books and articles written by 'doctots ' that had proven how they cured this as it needs anti fungal .
       I saw him and his wife several times and we continued to have discussions and new CT scans . The mass has grown little bit but not massively . But I can not convince them that he needs biopsy or resection . So after almost one year we are at the same place as we were a year ago. So this is the 'uncertainty' in medicine . I am sure that he has cancer . He and his wife is convinced that he has fungal infection. And till we do open biopsy we don't know what it is .(Unless he comes with wide spread cancer in next few months )!

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