A recent piece by Dalrymple in the Telegraph highlights the difficulty of determining the efficacy of breast cancer screening, and in the process, reveals the difficult questions doctors confront on a wide range of issues:

I remember going once into some detail with a patient about the pros and cons of treatment of his condition, and asked what he wanted.

“I don’t know,” he replied. “You’re the doctor. You decide. What would you do?”

A perfectly reasonable question, and a perfectly reasonable attitude. After all, you go to the doctor for advice, not to be presented with a series of conundrums without unequivocal answer.

But what would I have done? I couldn’t answer the question because I didn’t know, never having been in the patient’s shoes. Besides, even if I had been in his shoes from the purely medical point of view, I still wouldn’t have been him.

In the end I advised him to take the treatment, though to this day I am uncertain whether I was treating his condition or my anxiety.