Aesthetic
Mark Crislip
To a physicist, beauty means symmetry and simplicity. Michio Kaku,
Physicists, more than any other science, talk about the beauty in the field. Medicine? It doesn't have a lot of beauty by that definition. Medicine is usually messy and uncertain, and few things are as far from beauty as pus.
Still.
I do have an aesthetic when it comes to ID. I like the history, physical, and diagnostics to be consistent, and the therapy makes sense. Such a case may not be beautiful in the classic sense, but there is a satisfaction when a case comes together. Makes me feel very John "Hannibal" Smith.
The history, physical, and diagnostics often diverge, as patients do not read the textbook before coming to the hospital, but I find that beautiful as well. Diseases presentations are like variations on a Bach sonata. If you understand the infection, you can always hear the underlying tune. Those variations are often at the heart of this blog.
But the real ugliness comes in the treatment. And ugliness most often manifests at 2 in the morning, when inexperienced residents make decisions that are often, to quote Wolfgang Pauli, not even wrong.
And ugly.
The most common bit of ugliness is changing the antibiotics from treating the known infection, usually S. aureus, to broad-spectrum, because the patient has fevers. I have whinged about this ugliness many times. It. Drives. Me. Nuts.
But the most recent recurring aesthetic abomination is to treat stable, indolent infections with multiple antibiotics before any diagnostics are obtained for osteomyelitis. Chronic lung abscess. SBE, with an emphasis on the S. So often antibiotics are given when there is absolutely no hurry, and they only serve to mess up the cultures. Happens all the time with discitis. Ugly
Treating for organisms with no probability of being present, such as anaerobes in the edentulous or acute aspiration. Ugly.
Giving the wrong antibiotic for a known infection. Vancomycin for MSSA as the most common example. Ugly.
Not only is it suboptimal medicine, but it is also aesthetically ugly.
I am not a fan of ugly.
I don't know the solution. Sometimes I think infections should be like heme onc, treatment limited to ID docs and only ID docs. But that's not practical. It is a shame we do not have any devices that allow people to have virtually instantaneous communication with experts anytime/anywhere or allow access to the world's medical information by entering simple search terms. It would make medicine so much less ugly, like the ability to prevent severe COVID.
I guess the ugliness will just have to continue.
Rationalization
The A-Team https://www.shmoop.com/quotes/i-love-it-when-a-plan-comes-together.html