Details of a fascinating case circulated widely this month on X, shared by an emergency physician in the United States. It involved an elderly patient in refractory ventricular fibrillation, resistant to five defibrillation attempts, epinephrine, and amiodarone. As the emergency department team debated the use of dual-sequential defibrillation — a technique employing two defibrillators simultaneously — the patient achieved return of spontaneous circulation. The patient subsequently arrested again, underwent five additional shocks, further pharmacological interventions, and ultimately a stellate ganglion block using bedside point of care ultrasonography, which restored stability.
From a UK perspective, the discourse surrounding this case was not one of awe but of critical analysis. Beyond considerations of do-not-attempt-cardiopulmonary-resuscitation orders and a patient’s escalation status, a more profound question emerges: Does contemporary medicine risk becoming performative? Is the pursuit of ‘exciting’ interventions always aligned with the pursuit of optimal patient outcomes?
A Divide Across the Pond
The contrast between US and UK medical culture is perhaps illuminated in cases such as these. In the United States, the prevailing ethos of medicine often leans towards high-stakes interventions and a willingness to employ novel or experimental measures in critical situations. This approach is, at times, almost cinematic and adrenaline-inducing. Structural incentives, including the fee-for-service model and litigation concerns, may further drive this inclination toward interventionism.
In contrast, the UK medical framework prioritises adherence to protocol and resource allocation. This distinction is not merely procedural but reflects deeply ingrained philosophical attitudes towards medical practice.
Which approach ultimately serves the patient better? The inclination toward aggressive escalation is often underpinned by the assumption that more intervention equates to better care. However, this assumption is not always true. Medicine is not merely about action but about the selection of the right action at the right time. There is an inherent trade-off between intervention and prudence, between immediate response and long-term outcomes.
Every additional intervention carries risks — whether in the form of procedural complications, drug side effects, or the downstream consequences of too much medicalisation.
Should Medicine Be ‘Boring’?
The notion of ‘heroic’ medicine permeates popular TV programmes like House MD or Grey’s Anatomy. In these medical dramas, asingle doctor might float seamlessly between performing a craniotomy in one scene and a hip replacement in the next. But does this archetype align with the reality of optimal medical practice?
The evolution of medical sub-specialisation is predicated on an empirical truth: Expertise enhances patient outcomes. The more refined a skill set, the lower the margin for error, and the greater the likelihood of success. Consider the question: Whom would you prefer operating on a loved one? A surgeon electrified by the high-stakes nature of the procedure, pulse racing and hands trembling from adrenaline? Or a clinician so experienced that the act is second nature, performed with a level of precision bordering on the mechanical and the mundane?
Mastery in any domain — whether in surgery or the performing arts — is not characterised by emotional passion and intensity but by a state of effortless execution. A concert pianist does not actively deliberate on each keystroke; they simply play. Likewise, the best medical decisions stem from repetition, experience, and an absence of anxiety. The ideal doctor is not a dramatist but a technician — one whose expertise is so refined that their decisions are based on evidence and pattern recognition rather than impulse.
Experience fosters composure, and within that composure lies the capacity to perceive important details — the subtly bleeding vessel, the nearly undetectable shift in cardiac rhythm, the critical but easily overlooked clinical sign. Medicine, particularly in acute care, will always entail moments of urgency, but the romanticisation of medicine as a spectacle is a misdirection.
The most effective medicine is not sensational — it is systematic, data-driven, and, if we may say, unremarkable. Because, in the end, it is the unremarkable that saves lives.
Arya Anthony Kamyab is a foundation year 1 doctor working in the Northeast of England. You can follow him on Instagram@aryak.writes.
COMMENTARY
Should Medicine Be Boring? The Case for Methodical, Evidence-Based, and Unremarkable Care
DISCLOSURES
| April 01, 2025Details of a fascinating case circulated widely this month on X, shared by an emergency physician in the United States. It involved an elderly patient in refractory ventricular fibrillation, resistant to five defibrillation attempts, epinephrine, and amiodarone. As the emergency department team debated the use of dual-sequential defibrillation — a technique employing two defibrillators simultaneously — the patient achieved return of spontaneous circulation. The patient subsequently arrested again, underwent five additional shocks, further pharmacological interventions, and ultimately a stellate ganglion block using bedside point of care ultrasonography, which restored stability.
From a UK perspective, the discourse surrounding this case was not one of awe but of critical analysis. Beyond considerations of do-not-attempt-cardiopulmonary-resuscitation orders and a patient’s escalation status, a more profound question emerges: Does contemporary medicine risk becoming performative? Is the pursuit of ‘exciting’ interventions always aligned with the pursuit of optimal patient outcomes?
A Divide Across the Pond
The contrast between US and UK medical culture is perhaps illuminated in cases such as these. In the United States, the prevailing ethos of medicine often leans towards high-stakes interventions and a willingness to employ novel or experimental measures in critical situations. This approach is, at times, almost cinematic and adrenaline-inducing. Structural incentives, including the fee-for-service model and litigation concerns, may further drive this inclination toward interventionism.
In contrast, the UK medical framework prioritises adherence to protocol and resource allocation. This distinction is not merely procedural but reflects deeply ingrained philosophical attitudes towards medical practice.
Which approach ultimately serves the patient better? The inclination toward aggressive escalation is often underpinned by the assumption that more intervention equates to better care. However, this assumption is not always true. Medicine is not merely about action but about the selection of the right action at the right time. There is an inherent trade-off between intervention and prudence, between immediate response and long-term outcomes.
Every additional intervention carries risks — whether in the form of procedural complications, drug side effects, or the downstream consequences of too much medicalisation.
Should Medicine Be ‘Boring’?
The notion of ‘heroic’ medicine permeates popular TV programmes like House MD or Grey’s Anatomy. In these medical dramas, asingle doctor might float seamlessly between performing a craniotomy in one scene and a hip replacement in the next. But does this archetype align with the reality of optimal medical practice?
The evolution of medical sub-specialisation is predicated on an empirical truth: Expertise enhances patient outcomes. The more refined a skill set, the lower the margin for error, and the greater the likelihood of success. Consider the question: Whom would you prefer operating on a loved one? A surgeon electrified by the high-stakes nature of the procedure, pulse racing and hands trembling from adrenaline? Or a clinician so experienced that the act is second nature, performed with a level of precision bordering on the mechanical and the mundane?
Mastery in any domain — whether in surgery or the performing arts — is not characterised by emotional passion and intensity but by a state of effortless execution. A concert pianist does not actively deliberate on each keystroke; they simply play. Likewise, the best medical decisions stem from repetition, experience, and an absence of anxiety. The ideal doctor is not a dramatist but a technician — one whose expertise is so refined that their decisions are based on evidence and pattern recognition rather than impulse.
Experience fosters composure, and within that composure lies the capacity to perceive important details — the subtly bleeding vessel, the nearly undetectable shift in cardiac rhythm, the critical but easily overlooked clinical sign. Medicine, particularly in acute care, will always entail moments of urgency, but the romanticisation of medicine as a spectacle is a misdirection.
The most effective medicine is not sensational — it is systematic, data-driven, and, if we may say, unremarkable. Because, in the end, it is the unremarkable that saves lives.
Arya Anthony Kamyab is a foundation year 1 doctor working in the Northeast of England. You can follow him on Instagram @aryak.writes.
Any views expressed above are the author's own and do not necessarily reflect the views of WebMD or Medscape.
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