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Cancer Care Chronicles
March 26, 2020

A Totem for Ataxic Medical Deontology

Author Affiliations
  • 1South-West District of General Medicine, Local Health Authority Cuneo 1 (ASL CN1), Cuneo, Italy
JAMA Oncol. 2020;6(5):637-638. doi:10.1001/jamaoncol.2020.0267

I looked at the bedside clock once again. It must have been the millionth time that night. I could not fall asleep. All my thoughts kept going back to a few days earlier, when a colleague of mine accused me of having delayed a diagnosis of cancer, and these accusations were expressed directly to the patient who, in turn, referred them to me. This news came out of the blue and was like a punch in my face. I searched deeply inside my brain and my conscience, trying to understand if I had had any kind of responsibility for what had happened to that patient. I started questioning my clinical work by breaking it down and smashing it into lots of small pieces, like a glass hit by an iron club. In our daily medical practice, we usually cling to scientific knowledge and evidence-based medicine, hoping that they might help us unravel the wool ball of uncertainty that we face. Sometimes during a tennis match, the ball hits the net and remains suspended in the air for an instant, leaving all who watch uncertain which side of the net it will fall on. Similarly, there are some situations in medicine where the risks and benefits are difficult to estimate; uncertainty reigns supreme; and only fate seems to determine which side of the court a patient’s outcome will fall on.

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