“Everyone has a plan until they get punched in the mouth.” This quote, often attributed to boxing champion Mike Tyson, is popular because it expresses a simple fact: untested plans hold little value.

This axiom applies to ideology and philosophy. It is easy to clutch to unchallenged beliefs. That is, until they are “punched in the mouth.” This was my relationship to medicine and healthcare as a patient, which is best described as a conservative approach.

As with most beliefs, I came to mine sincerely. However, a couple of years ago, I had an accident not dissimilar to being punched in the face that left me partially blind in my left eye. This life altering accident challenged my confidence in medical conservatism, as I hoped that a medical intervention might restore my eyesight.

But before we get to my accident, it is necessary to explain how my preference for medical conservatism developed. As a child and teenager, I was treated extensively for allergies and respiratory issues. I had regular appointments with a range of specialists to explore the causes of my ailments and potential treatments.

The treatments and specialists of twenty years ago were largely ineffectual. I rotated through a host of tests, medications, and medical professionals. Yet my wheezing and coughing – although not particularly severe – never went away. Of all the state-of-the-art interventions, the only ones that had much benefit were over the counter medications.

Then, in my late teens, my problems dissipated. The medical professionals simply said I “outgrew” my respiratory issues. Years of treatment gave way to an admission of ignorance. The experience left me cynical and with the impression that the practice of medicine was not particularly scientific.

My cynicism faded with time. Yet, I was left with an unnamed philosophy for my preferred medical care. I mostly avoided doctors and medicine but received satisfactory care a few times since. I also grew to appreciate a certain kind of medical professional who wasn’t afraid to say “I don’t know” when faced with a question, or “Let’s wait and see” when confronting a problem. I realized time is often the greatest cure and the best medical care is commonly guidance and monitoring rather than aggressive intervention.

I did not have a name for my healthcare preference until I came across a podcast episode on EconTalk featuring physician Adam Cifu. During that episode Dr. Cifu discussed his 2019 paper, published with a team of other physicians, titled “The Case for Being a Medical Conservative.” The conversation revealed that my preference for care had supporters in the medical community. After listening, I read the paper online. The closing section distills what it means to be a medical conservative:

“In the end, the medical conservative stands in awe of the human body. We recognize that our knowledge and best models only rarely predict the success of a new intervention. We see true medical progress as slow and hard, in large part because nature has provided the human body with inherent healing properties.

The wisest of conservative physicians understand and embrace how little effect the clinician has on outcomes. While many may call this frame of reference nihilistic, the conservative clinician sees it as protective against our greatest foe—hubris.”

This was the first time I encountered an explanation for why the treatment I received as a child and teenager frustrated me and why my later preference for minimally invasive care later led to satisfactory experiences. That is, until I was “punched in the face.”

Like many accidents, mine was the result of a thoughtless, preventable mistake. While exercising at my house, I improperly installed resistance bands in a door frame. As I pulled back on the bands, the door gave way and the resistance bands broke loose. The anchor for the bands, which consist of a canvas loop and hard foam anchor, launched at my face. Without realizing it, I reflexively turned my head to avoid the collision. Unfortunately, my reaction turned my left eye directly into the path of the foam anchor. The impact sent me crumbling.

I immediately knew something was wrong. At first, I figured the impact was so severe my left eye immediately swelled shut, which limited my vision. After touching my face and seeing a small amount of blood on my hand, I turned to a nearby mirror and saw my face wasn’t swollen, instead I had a small cut above my left eye and my eyeball looked bloody. I closed my right eye and my fear was realized, I was blinded in my left eye.

At the emergency room, the ER doctors performed a simple assessment and sent me home. They determined there was little they could do. I had to wait to see an eye surgeon the next day. While this frustrated me, I understood their rationale. Eyes require specialized care.

After consulting with an eye surgeon the next morning, I had a clearer diagnosis: the retina in my left eye had been traumatized and was possibly detached. I was referred to a retina specialist that afternoon to determine whether I would be a candidate for surgery.

My father drove me to a retina practice in Buffalo. After a series of tests, I was seen by Dr. N. I immediately appreciated his approach. He expressed sorrow for my accident then went into a patient, clear explanation of my diagnosis and course of treatment. 

My retina was not detached. Rather, it was incredibly distorted, particularly the center of my retina where the impact occurred. It also had a small hole. He showed me a comparison to my right eye for reference. Blood had also accumulated in my eye, further impairing my vision.

He explained that surgery was not appropriate at this time. Instead, the best option was to see if the eye would heal itself. From his experience, young people have some success with this approach, although he was careful not to make predictions or promises. He set an appointment for the following week to check my progress and monitor any further complications.

My initial follow up was promising since I regained some peripheral vision. Therefore, surgery remained a counterproductive and highly risky option. Instead, I followed up again two months later.

Unfortunately, my next visit came with disappointment. I showed little sign of improvement. Dr. N regretfully explained this was likely going to be the final state of vision in my left eye. I was adapting well to my injury, but the news was still difficult to hear.

Despite his assurances and my preferred patient care, the allure of surgery was present. Would a risky surgery with a difficult recovery be any worse than accepting my diminished left eye? Was the cautious approach correct when time in those early days was crucial to my recovery? Describing a course of treatment as a “medical option” obscures what patients confront: difficult and life changing choices. And the conservative approach of hoping the eye would heal itself came with real risk; namely, I hoped my eye would heal on its own rather than gamble with risky surgery while time was of the essence.

People were not shy about sharing their opinions about the choice I made. People asked if I would regain my eyesight. I repeated what Dr. N told me since I trusted his opinion, that I chose to see if my eye would heal itself rather than pursue risky surgery. Many expressed disbelief there was not a simple surgical solution. Some individuals questioned my care and encouraged me to get a second opinion. Despite the severity of my injury, my trust in Dr. N held. Nonetheless, I sought a second opinion to put the matter to rest.

I scheduled an appointment with another retina practice in eastern Pennsylvania. After routine scans and tests, I met with Dr. C. In many ways, Dr. C and Dr. N are very different physicians. Dr. C wore scrubs instead of Dr. N neat professional dress. Also, instead of speaking softly and slowly, Dr. C spoke rapidly, joked around, and moved energetically.

Although he had a distinct personal approach, Dr. C was exceptional. He expressed regret for my injury, carefully explained his opinion, and provided the same advice as Dr. N: take a wait-and-see approach. Differences in style aside, their medical care and judgments were strikingly similar.

Given the opportunity, I asked Dr. C a candid question, “If I would have come to you instead of another doctor after my injury, would you have performed surgery.” Dr. C half laughed before providing a declaratory, “No!” Although I received the same opinion, it was satisfying to know the noninterventionist approach was the appropriate strategy.

Despite the desire to regain my vision, my conviction towards medical care remains unchanged. My left eye and ideology may have been “punch in the face,” but my commitment to medical conservatism is intact. This has less to do with personal courage or commitment and more to do with the professionalism of doctors and their staff that used a conservative approach in practice. While this did not heal my eye, it did guard against a hubristic theory of medicine that could have worsened my condition. While I am just one patient, I hope more patients and healthcare professionals consider the case for being a medical conservative.

Download a copy of A Conservative Approach to Healing: Lessons from an Eye Injury – Seth Higgins

Bio: Seth Higgins is a native of Saint Marys, Pennsylvania but currently resides in Philadelphia. He occasionally writes about politics, policy, and culture. Given the option, he tries to stay out of the doctor’s office.