Never Underestimate the Power of Chance in Shaping Medical Diagnoses
Dr David Mokotoff
Retired Cardiologist, BayArea Heart founder
Science will get you so far in making complex medical diagnoses, and it always amazes me when happenstance rules the day.
Some call it luck, serendipity, or fate, but “accidental” discoveries are important in discovering medical diagnoses and treatments. My wife’s recent loss of vision and its correction bore this out.
But before we get to her discovery, let’s examine other pivotal medical treatments. Alexander Flemming accidentally discovered penicillin, the first antibiotic.
Consider the profound impact of a team of Danish researchers, engrossed in their study on protecting pregnant women against malaria, stumbling upon a potential cancer treatment.
Or the sheer luck of discovering an implantable heart pacemaker and the first blood thinner, warfarin. These are not just accidental discoveries; they are revolutionary game-changers.
My wife has an inherited disorder of her corneas called granular corneal dystrophy. To be more exact, hers is the Type 2 or Avellino dystrophy. It is so named because descendants of the disease came from the small town of Avellino in southern Italy. And yes, her ancestors are from this region.
Plaques develop in the usually clear cornea (the front part of the eye) early in life but often do not affect vision until one’s sixth or seventh decade. The only “curative” treatment is a corneal transplant, but these results are not permanent and not without complications.
My wife had her cataracts removed in 2017, but in 2019, she developed almost total blindness. Half a dozen “experts” were sure her dystrophy was responsible. She even had a laser procedure to improve her vision at a world-renowned university eye center. It did nothing to improve her vision.
Finally, her cataract surgeon discovered the cause: scar tissue behind her lens. The cure is quick, painless, and easy with a YAG laser. He had misdiagnosed it for over a year. Grasping at straws, he finally decided to perform this in-office procedure, still believing it not to be the culprit. Instantly, her vision returned. In this Medium post, I have detailed her journey and how and why medical experts often miss the obvious.
Her vision is worsening again, and this time, it is because her corneal dystrophy is worsening. Her corneal specialist is trying to buy her some time by prescribing hard contact lenses.
When the optometrist’s assistant placed the lenses in her eyes and asked her to read the eye chart, her visual acuity was worse than better. Both of us had the same thought. This must be someone else’s prescription. We were asked to return to the waiting room before seeing the optometrist. While we were sitting there, and for no apparent reason that my wife can recall, she took her +3.25 diopter reading glasses out of her purse and put them on.
She began to smile and then laugh. Outloud, she exclaimed, “I can see, I can see! I can read the words on the television, and everyone’s face is crystal clear!”
By this time, everyone in the room was staring at her. I asked her to read the words on the far-wall television screen, and she read them out loud to everyone. I shook my head in amazement. “I don’t know how that’s possible.”
Moments later, after seeing the doctor, she gave us an explanation. Yes, the prescription was wrong, but that is not unusual when dealing with an irregular corneal surface. We were told it might take two or three tries to get it right. The reading glasses that add diopters to one’s vision corrected the negative diopters (used for long-distance vision) to a more accurate setting.
What happened can be categorized as luck, karma, or coincidence, depending on your religious or spiritual beliefs. My wife doesn’t know why she reached for and tried on her reading glasses. I am sure the eye doctor could not have predicted this.
I have seen this too many times during my years of medical practice to discount it. Spiritually, it could be termed karma or the universe conspiring to help you. Belief in the “law of attraction” could be an explanation. My wife fervently felt that the contact lenses would work, and when they did not, perhaps some unseen force guided her and her doctor to the solution.
A deeply religious person would call it a miracle born out of deep faith. My wife, being a devout Catholic, had even prayed for help with her worsening visual acuity. She never told me this at the time but recently confirmed it.
An agnostic or atheist would call this a coincidence unrelated to anything else. In other words, it is one of the trillions of random events in the universe. Their worldview does not account for anything other than the laws of nature and science when examining causes and effects. And this begs another question. Can you be a doctor or scientist and still believe in miracles? I believe you can.
Doctors cannot always predict the future. I would have retired long ago by accurately predicting tomorrow’s lottery numbers if they could. However, we can look at the patterns and risks of patients with complex diseases. We can make educated guesses and recommendations, but exact predictions are fraught with error. This is the reason I never told a patient or their family that they had an “x” number of months or years to live.
I will never forget one of my patients, Natalie. When I first met her, she was in her early 90s with congestive heart failure from a leaky heart valve. Medications worked up to a point, but the problem was mechanical. As with a bad valve in your car, the only cure is replacement. But she had other medical problems, and when I suggested heart surgery, she declined. I offered but never pushed the idea.
Unsurprisingly, her heart failure worsened. Medical studies would predict she had only a few more years to live. However, she lived to be 106! She would delight every six months when she came to see me, smile and say, “Are you surprised to see me?” I was truthful and said, “Yes.” Natalie lived way past an age predicted by medicine. It was not because of my great care or any misdiagnosis. It was because she was lucky.
I have a deep trust in the scientific method. I don’t trust anecdotal data, but I don’t entirely discount it either. I prefer high-quality scientific studies for discerning cause and effect in medicine. If they can be done, I believe the best scientific studies are prospective, double-blind, randomized, and crossover in design. The recent pandemic and errors in government policies and predictions made me question these beliefs.
But I have also seen enough surprises not to have faith and belief that some external or higher power is working alongside us. Therefore, faith, religion, or spirituality can co-exist with science and medicine.
Dr. Barron Lerner discusses the role of luck in medicine and how physicians are reluctant to embrace it.
The likeliest reason that luck — good or bad — is so often disregarded is that, at first glance, it appears contrary to the scientific basis of medicine.
In other words, most doctors feel that luck is the opposite of good medicine and science. They cannot coexist. I say they can, and since doctors make mistakes, don’t know everything, and can’t predict all outcomes, that is good. It is unbridled hubris to believe otherwise.
In closing, I will offer some words of wisdom from my former partner, who completed a difficult coronary stent procedure. When I complimented him about the successful results, he responded.
“Sometimes it’s better to be lucky than good.”
