16/8/23, 17:09 “Shotgun” Diagnosis | Harvard Magazine

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MONTAGE | OPEN BOOK

“Shotgun” Diagnosis On Readers’ Radar

SEPTEMBER-OCTOBER 2023
1. The Sound of Science
2. The Elephant in the Room
3. Michelle Yeoh’s Three Tips for
Success
4. A “Scholar’s Scholar”
5. Embracing AI

Often the best (and hardest) thing to do is nothing: “Let’s just keep watching for now.”
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W
of modern medicine and doctoring as scientific. And
E LIKE TO THINK Getting Close, in Selma
so they are, but health outcomes remain subject to chance like every
other aspect of life: the heart attack patient who dies despite expert
EMT care because road construction delays the ambulance’s path to the hospital that

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16/8/23, 17:09 “Shotgun” Diagnosis | Harvard Magazine
afternoon. That example appears early in Random Acts of Medicine: The Hidden Forces That Sway State-Sponsored
Doctors, Impact Patients, and Shape Our Health (Doubleday, $30), by Anupam B. Jena, Newhouse Discrimination
professor of healthcare policy, and Christopher Worsham, instructor in medicine—both
physicians. From chapter six, on the relative merits of action versus inaction:
Off the Shelf

IF PRESSED, most physicians will admit that they err on the side of more medical care. We
ourselves are not immune to it. We’ve given antibiotics when we were pretty sure an infection
was viral and didn’t require them; we’ve tested for all kinds of rare and exotic diseases, even
when we know the chances of the patient having the disease were extremely low (what some
refer to as the “shotgun” approach to diagnosis); we’ve ordered CT scans of every part of the
body without expecting to find anything, “just in case.” Most of the time, this care ends up
being unnecessary. But every once in a while, what is “unnecessary” yields a finding that saves a
life, and the tendency toward more care is reinforced.

How do we solve this conundrum? As the Harvard cardiologist, writer, and national
correspondent for The New England Journal of Medicine Dr. Lisa Rosenbaum has written,
“Perhaps the most accurate conclusion is that sometimes less is more, sometimes more is more,
and often we just don’t know.” It’s a frustrating view of the situation, but as practicing doctors
we can’t deny its truth. All we can do is, through continued study and research, try to illuminate
the gray areas, in hopes that in time they can be made more black and white.

In the meantime, we’re reminded of a piece of med school advice from a seasoned trauma
surgeon evaluating a clinically unstable patient—a quotation originally attributed to a 1940s
theater producer frustrated with an overacting cast member: “Don’t just do something: stand
there!” Most doctors would have to acknowledge that this is sage advice, if hard advice to
accept. Because when you’re standing at the foot of a bed, looking at a patient facing life or
death, and you’re asked, “Doctor, what should we do?” often the hardest answer to give is,
“Nothing. Let’s just keep watching for now.”

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16/8/23, 17:09 “Shotgun” Diagnosis | Harvard Magazine

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