On the surface, medicine and foreign policy would appear to have little in common. They are two widely disparate fields. However, taking a step back, one can see that both demand a certain rigor and involve the application of problem-solving skills to carefully manage conditions that are often complex and fraught with peril. As necessary, both employ interventions to achieve their goals. On occasion—whether due to human error, unforeseen circumstances, or some combination thereof—those interventions can have undesired consequences and cause greater harm than good. At such times, the only ethical response is to critically reexamine the reasoning and practices that led to the current state of affairs and then to institute whatever changes are needed to improve the situation. That can include withdrawing something which had been thought to help.

In today’s New York Times Magazine, Dr. Lisa Sanders relates the fascinating story of how one young medical resident handled a particularly confounding case and, in the telling, imparts a lesson that may offer guidance far afield:

The Healing Problem

1. Symptoms

As Dr. Lisa Pastel, a resident in her second year of training, entered the brightly lighted cubicle, five faces turned to greet her. The patient, a pleasant-faced middle-aged man in a wheelchair, invited her in. His wife sat next to him, and their three children sprawled across the cool linoleum floor with schoolbooks opened before them. For this family, like so many caught up in the care of a chronically ill member, going to the hospital had become just another family routine.

The patient leaned forward to shake the doctor’s hand. His grip was firm and his hand warm, the doctor noted, but not hot or sweaty. He was tired and achy, he told her, and he had a fever he just couldn’t shake. He had been well until a couple of days ago — or at least as well as he could be, considering all his other health problems, he added, smiling through a bushy, gray-streaked beard. Because of this fever, he visited his doctor, who told him he had to go into the hospital. That would be excessive for most of us, but this patient had an impaired immune system, and close observation and strong antibiotics were necessary.

He was 47. Four years earlier, he had gastric bypass surgery. It worked, and he lost more then 100 pounds. Before the surgery, he had diabetes, high cholesterol and sleep apnea, but those diseases melted away along with the excess pounds.

About two years later, he developed a hernia, a common complication of abdominal surgery. He had an operation to fix it, and that’s when the latest round of trouble began. After the operation, he developed a serious infection. He needed weeks of intravenous antibiotics, and he was still living with the consequences: the incision that the doctors made to repair the hernia never healed. It remained an open wound, and no one could figure out why. That wasn’t the only mystery: six months ago, routine blood work showed that he had developed anemia (too few red blood cells) and neutropenia (too few infection-fighting white blood cells). He had a slew of tests, but no one could explain this newest complication either. [full text]