Submitted for your approval: When the art of medicine veers into the twilight zone

The practice of medicine encompasses both art and science.

“Three patients may find themselves in the same situation…but may tell three different stories about it,” primary care physician Suzanne Koven, M.D., M.F.A., wrote in her guide for clinician writers.

The art of medicine is exemplified by the above sentence: focusing initially on the patient’s subjective input before arriving at an individualized treatment plan that may stray somewhat from recognized standards of care.

A consequence, however, was that I often spent some time each day feeling as if I were in the twilight zone.

The Twilight Zone was a hit television series, created by Rod Serling, that aired years ago and still lives on various streaming services. Each episode typically ended with a unique, often unexpected, twist.

Feeling as if I entered the twilight zone was synonymous with patient encounters that felt surreal, such as the following:

• An older man always agreed to a flu shot. He was sure the vaccine contributed to his health and quality of life. Another older man always declined a flu shot. He was sure it was a conspiracy by the medical community to make people ill, to increase the need for medical services.
• A patient with acute mechanical lower back pain after playing tennis insisted on X-rays and a referral for subspecialty care. He had an MRI and 18 chiropractic adjustments, and felt improved after six weeks. Another patient with acute mechanical lower back pain after playing tennis adhered to a conservative treatment plan and felt improved after six weeks.
• An elderly man, happily married, with erectile dysfunction (ED) trialed a vacuum pump, oral medications and penile injections, and finally underwent surgery for an implant. Another elderly man, happily married, declined all possible interventions for ED. He and his wife were “fine with the way things are.”
• A patient with a sore throat “since this morning” insisted that antibiotics were necessary. Another patient with a sore throat for seven days preferred not to take antibiotics unless recommended.
• An elderly man with severe dementia remained at home as his multiple family members worked together to meet all his care needs. Nursing home placement was never considered. Another elderly man with mild dementia was placed in a nursing home soon after one episode of urinary incontinence. His multiple family members rarely visited.
• A teenager had one pimple. He and his mother insisted on systemic therapy. Another teenager had significant acne. He and his mother would only accept topical therapy.
• A patient with metastatic large-cell cancer declined any treatment or referrals and lived four more years. Another patient with metastatic large-cell cancer requested the most aggressive treatment and died in six months.
• A woman slipped at a store while shopping and was relieved to know she only had a sprained ankle. Another woman slipped at a store while shopping, had the same diagnosis and handed me the business card of the attorney she saw prior to coming for an evaluation. She was planning to litigate.
• A woman requested to see my office manager to complain because I was 30 minutes late seeing her. I was giving background information to emergency medical personnel who were transporting an ill patient to the hospital by ambulance. Another patient on the same day, whom I saw one hour late, started off by saying, “Gee, I hope the person that just left your office in the ambulance is OK. You’re really having a busy day…are you doing all right?”

The Twilight Zone theme music was usually heard, in my head, during such encounters.

The art of medicine will always interplay with the science of medicine, even in this high-tech era. It should continue to be taught, emphasized and modeled for health care trainees, as all will enter the twilight zone during some of their patient encounters.

But unless the younger generation watches old Twilight Zone reruns (and has the theme music ingrained), surreal encounters are sure to be associated with something more up to date!

William Sheahan, M.D., is a family physician based in Florida who retired in the last year after a 40-year medical career. He earned his medical degree at the University of Virginia School of Medicine and, in March 2026, received a foundational certificate in narrative-based medicine from the University of Toronto. He has enjoyed writing on various medical topics over the years. Along with clinical studies and presentations, he is the author of three volumes of Patients Say the Darndest Things and A Doc Who Jots: The more you know about your patient’s story …