Wednesday, August 28, 2013

Time the healer


They say "time heals all wounds". Does it?
It certainly heals a lot of wounds, sometimes very efficiently. Grief, anger, hate etc gradually subside and may eventually disappear. At other times scars are left. You stop hating somebody but keep avoiding him. Your grief disappears only to be aroused when memories are brought back.
Problems may be solved by the mere passage of time. A bad neighbour may decide to move away for his own reasons. Financial hardship may be solved by unexpected inheritance or a job coming into your way without you planning for it. The ancient Chinese proverb: "If you sit by the river long enough, the body of your enemy will float by" may sometimes be true but certainly not all the time and not even most of the time.
In spite of the immense healing power of time, it certainly does not heal all wounds. As someone commented sarcastically, "if time heals all wounds, why the hell am I paying for health insurance?" Waiting is prudent in some situations, but action may be needed to solve a problem, improve relations between opponents, ameliorate severe grief or intense anxiety. Actions may be effective, may not be and may even worsen situations. When to wait and when and how to act needs a lot of wisdom which not many people are endowed with.
In medicine:
Many illnesses recover spontaneously. Infections like influenza, sore threat, various diarrhoeas may recover with time merely as a result of the natural defence of the body. Many obscure symptoms come and go without being diagnosed and without treatment.
Diagnosis of an obscure illness may become more obvious with the passage of time hence the well known saying by physicians: "wait and see". Acting too early or interfering too much may bring unnecessary suffering and may itself produce complications. I remember one of my teachers saying during a clinical round: Patients do better the less you interfere with them! His saying was not intended to mean exactly what it says, but rather to stress that decisions to interfere should not be taken lightly and should be restricted to what is necessary and be on a good ground.

On the other hand waiting for time to cure an illness or to help in making a diagnosis carries the risk of development of complications or making a diagnosis too late for treatment to be effective. Decision to wait or to act depends, like all decisions, on weighing the benefits against the risks. This is at the core of good clinical judgment.

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