[jrapdx3]

The ancient wisdom is the practice of medicine is as much art as science. There is "evidence" supporting many practices. As in every complex endeavor, evidence is not static, but evolving constantly.

Evidence is necessary but by itself insufficient. We must use our own power of observation combined with what we know and what we've learned to decide what to do.

So your question is indeed profound, cuts to the core of the issues. Intuition is one way to phrase it. I once heard a colleague say we're not paid because of what we know, but for the judgement we exercise about advice or treatment to offer.

Each human is indeed unique. Even identical twins are in fact not exactly the same. Rules have limits when no two cases are precisely the same, it always comes down to that very intuition you are intuitively aware of.

After all, we frequently wish to have a second opinion. I do often enough too. I like the saying, get 5 experts in a room, and you're likely to get at least 6 opinions on any subject.

Who said decisions should be easy? I sweat over each and every one.

[pinkyand]

> Who said decisions should be easy? I sweat over each and every one.

True medicine is a really hard job.

So maybe the way decide in medicine should be changed ? maybe they be done remotely but through a recommendation system so that each doctor would get plenty of nearly similar cases - so he could practice and hone it's intuition ?

Or since the complexity is really too great (and as a patient hearing that "this is art not science" isn't that encouraging , even if true) maybe the overarching goal of medicine should be to remove the art, and we finally have the tools to do it(watson, machine learning ,remote diagnosis , etc...) ?

And if we agree that that's a good goal, maybe the current way we try to do it (evidence based medicine) , is a bit clumsy due to both the science and the resistance by doctors , but at least it's going in the right directorion.