By Evan Falchuk

In the mail today, I received from a friend a copy of the book Golf is Not a Game of Perfect. For golfers, the title should tell you all you need to know — that our desire to play a flawless game is often the biggest barrier to a successful round.

This has nothing to do with health care….or maybe it does. Today, the Happy Hospitalist, asks, of medical decisions: “Is It Reasonable to Get it Right 100% of the Time?”

The Happy Hospitalist is right that doctors are not infallible, and it is not reasonable for us to expect them to be:

In every step of the way, clinical judgments are being made in the evaluation, diagnosis, treatment and management of disease and complications of disease. This is not protocol driven medicine. This is real world clinical medicine. I have yet to manage a patient that could be described perfectly in a start to finish How to Manage book. This is where years of medical school training, years of residency and patient contact experience and long hours in the office come into play.

But like a struggling golfer, our desire for perfection in medical care often stands in the way of good medicine. The Happy Hospitalist expresses the frustration doctors feel at the fear of being sued for bad outcomes, being forced to follow protocols that may not apply in their case, and being constricted in their ability to stop and think. It all contributes to worries that the next generation of doctors will lack the self-confidence they need to make sound medical judgments.

Still, I think the Happy Hospitalist’s post begs the question: If 100% accuracy is not reasonable, what is? Ninety percent? Eighty? Seventy? Sixty?