The art of the game

Tuesday, September 1, 2009

Change is always a challenge and September is change month for many athletes participating in fall sports. While football is the 800 pound gorilla in the room, many other sports from tennis to soccer and cross country, invite athletes from grade school to college to improve performance. The adventure is translating that performance in practice to results when the whistle blows and the game starts.

The same transition from practice to reality also happens in medicine. Years of medical school internship, residency and more training in fellowship allow physicians to spend a lifetime in training. They learn to understand the body and how it works, what can go wrong, how to fix it and sometimes how to step away and admit defeat.

In many sports, the opponent is an unknown quantity until game time. While one can prepare for eventualities, it’s difficult to know what is going to happen until the play begins. Coaches can make adjustments as the game goes on, but the other side is also making changes on the fly. The outcome of the game depends not only on skill, but also on the ability to change course in the middle of battle.

In medicine, disease and trauma are the opponents and the challenge they pose is ever changing. These foes are notorious for acting in unusual ways. Learning about classic disease presentation is relatively easy; crushing chest pain radiating down the left arm, associated with shortness of breath and sweating sounds like angina or pain from the heart. But heart disease is a sneaky opponent. It can present with heartburn and indigestion or there may be no pain at all, just shortness of breath or fatigue. Injuries are no less tricky. Hip injuries usually have pain in the hip, except when they present with knee pain. And some injuries resolve themselves spontaneously only to leave a potentially devastating complication. Knee dislocations can return to normal position but the trauma can damage arteries, increasing the risk of a dead leg.

Understanding the opponent means more than reading the textbook; it requires experience in seeing patients before, during and after their illness and learning variations of normal and abnormal. The physician seeing patients on Tuesday is a different and better physician than the physician on Monday. An extra day of experience and another patient encounter allows that much more bedside education.

Unfortunately, even that isn’t enough. Knowledge expands too quickly as science and technology leapfrog and it’s difficult to keep up to date. A generation ago, heart attacks were treated with weeks of bed rest, heart muscle was allowed to die and quality of life was a roll of the dice. Ten years ago, SARS and prion infections were stuff of Michael Crichton novels. This spring, H1N1 reared its head and the vaccine is already being produced.

After years of training, good doctors understand not only what they can do, but also what they can’t. Good physicians learn the limits of their skills and when to ask for help. And that help may come from the patient in terms of direction and limits as to what is acceptable. Not all patients choose to be subjected to all that high tech has to offer. Some acknowledge that it’s alright to not know exactly what’s going on and to accept some risk in their future.

On the field, coached and players assess their strengths and weaknesses and decide whether they match up well against their opponent. Decisions to run or pass, hit away or bunt, or to volley at the net, depend upon the assessment of the situation and how much risk they are willing to take. The ability to balance skill and risk lend to the grace and art of sport.

In medicine, the ability to take textbook science and make it work for the patient and perhaps effect a cure and meet their needs, makes for art as well.

Leave a Reply

This site uses Akismet to reduce spam. Learn how your comment data is processed.