Previous / Next

[20110828. screening endoscopy (6): Hoerr's law -- it is difficult to make the asymptomatic patient feel better]

Screening endoscopy에 대하여 생각하면 Hoerr's law를 떠올리지 않을 수 없습니다. 2011년 6월 5일자 endoTODAY에서 소개한 바 있지만 다시 한번 전문을 옮깁니다 (Am J Surg 1962;103:411). 과잉치료와 과잉진단이 난무하는 어지러운 현실에 경종을 울리는 아름다운 글입니다.

The surgeon is a man of action. By temperament and by training he prefers to serve the sick by operating on them, and he inwardly commiserates with a patient so unfortunate as to have a disease not suited to surgical treatment. Young surgeons, busy mastering the technicalities of the art, are particularly alert to seize every legitimate opportunity to practice technical maneuvers, the more complicated the better.

In an effort to remind my young colleagues, as well as myself, that our goal as physicians is the betterment of the lot of the patient, I have formulated a ten word statement that I have modestly named Hoerr’s Law.

It is difficult to make the asymptomatic patient feel better.

This is not to say that the patient with an asymptomatic cancer will not be helped by having it skillfully removed, even though he will feel no better than he did before the operation. On the other hand, there are patients who have benign surgically correctible conditions of which they are unaware. But surgeons, old and young, should ponder well the possible benefit to the asymptomatic patient before they advise on operation for such abnormalities as a slight bulge in the inguinal area, which may or may not develop into a significant hernia; a fibroid uterus, or a silent, solitary gallstone in a aged person. Operation for such conditions, on occasion, may be best, but its advisability should never be taken as a matter of course.

We should always let our judgments and recommendations be guided by the fact that we operate on patients, not on diseases.

Stanley O. Hoerr, M.D., F.A.C.S.
Department of General Surgery
The Cleveland Clinic Foundation
and The Frank E. Bunts Educational Institute
Cleveland, Ohio

99. 참고자료

1) EndoTODAY 건진 내시경