The 'middle path' and the perils of moderation in medicine.

ABSTRACT

The ‘middle path’ has been touted as a virtue in life and in medical practice, much more so in India, perhaps because of the cultural influence of the Gita (akarma, inaction) and the teachings of the Budhha (madhyamâ-pratipada, the middle way). While being moderate is in general a good trait in a medical practitioner, it can sometimes lead to inappropriate clinical decisions if these are guided solely by considerations of moderation. The chances of such an occurrence are high, given that medicine is an inexact science and often we do not have convincing evidence for or against a particular treatment or practice, and the doctor’s personality and personal convictions play a major role in determining the course of action. Even though practitioners exhibit the entire behavioural spectrum from therapeutic nihilism to cowboyish aggression, the large majority of doctors can be described as being moderate. Therefore, potentially more (albeit unintended) damage may be caused by this large group of well-meaning practitioners if they uncritically adopt a middle path for apparently no reason other than the fallacious assumption that moderation is always good.