The Goldilocks Problem: On Skepticism in Medicine

There’s a lot to be said for being a skeptic. Though not always kindly.

Say the word skeptic, and most people picture a Comic Book Guy-type cynic, or maybe someone philosophical and bearded — a Plato or a Hume.

But more often, skepticism gets thrown around as an insult.

“You’re just being difficult.”

“You’re not open-minded.”

“You’re just not getting it”

It’s shorthand for “you’re not buying my bullshit.”

Good.

Because in medicine, if you’re not a skeptic, you’re probably dangerous.

Skepticism: The Goldilocks Zone

At its core, skepticism is a tightrope walk between gullibility and dismissiveness.

Too soft, and you give everyone antibiotics for their viral cough and code paracetamol allergies because someone once got a headache.

Too hard, and you risk contributing to medical gaslighting, invalidating real distress, or missing something important.

A good skeptic lives in that uncomfortable middle ground. They hold uncertainty like a professional — curious, cautious, willing to shift, but not easily moved.

It’s the difference between listening carefully and believing everything you’re told. Between over-investigating pain and simply labelling it functional.

And let’s be honest: that middle ground is where most of the real medicine happens.

The Nocebo Trap

Skepticism isn’t just for patients. It’s for ourselves.

Doctors are famously bad at reflecting on our own plans. Once we’ve committed to a diagnosis, we build around it like scaffolding — reassurance, safety-netting, referrals that reinforce the hunch.

Meanwhile, symptoms evolve. But instead of stepping back, we label the patient “complex.” Or worse, “anxious.”

It’s how we create the nocebo effect, even without trying — by making patients feel unheard, over-investigated, or quietly disbelieved. Especially when our skepticism calcifies into condescension.

Skepticism means asking: “What am I missing?” Not: “What’s the quickest way to end this consult?”

Like I’ve said before, there’s three outcomes to a consultation:

1. What you came for

2. What you actually need

3. What gets you out of my room

When the all three align it’s a rare treat, but usually it isn’t. And let’s be honest, we know which one we’d pick and it’s rarely number 2.

The Spectrum: From Believer to Brick Wall

Some doctors believe everything. They write sick notes like it’s bingo. They prescribe “just in case” everything. They rarely say no.

Patients love them — until they don’t.

Until the endless reassurance fails. Until the tests show nothing, again. Until the cycle of dependency bites back. Until all these tests and treatments confirms that they must have something serious.

On the other end?

The cold shoulders. The ones who don’t believe anyone. The ones who hear “ongoing abdominal pain” and mentally tick IBS before the sentence ends.

They’re fast.

They’re firm.

They’re sometimes safe — until they’re not.

Until the “probably viral” was sepsis. Until the “just stress” was cancer. Until the patient never comes back — because they’re done being gaslit.

Medical gaslighting isn’t always intentional. Often, it’s a byproduct of burn-out, time pressure, or habit. But the impact is the same: a patient leaves feeling smaller, not safer.

Gaslighting: The Unintentional Sin

We rarely talk about how often gaslighting starts in good faith. In “you’re fine.” In “your bloods are normal.” In “nothing’s shown up.”

But when that’s all you say — when you skip the part where you sit with uncertainty, when you brush off the disconnect between symptoms and results — you stop being a skeptic. You start being a wall.

Skepticism doesn’t mean always saying no. It means leaving space for complexity. For stories that don’t line up cleanly. For people who don’t look sick but still are.

Because invisible illnesses don’t come with footnotes. They come with pain. Fear. And long histories of not being believed.

Professional Skepticism Is a Skill

It’s not just what you believe — it’s how you show it.

Skepticism, done well, is a dance. A soft push. A careful “I hear you, and…” It’s being honest about your doubt without demeaning the person who brought you their trust.

It’s saying: “I’m not sure.” Or: “Here’s what we do know.” Or: “Let’s revisit this — because I might be wrong.”

You can say no with kindness. You can doubt the story and still care deeply about the storyteller. You can be cautious without being cold.

That’s what makes skepticism clinical — not cruel.

Final Thought: Even Data Lies

Even numbers mislead. Even “the literature” shifts.

So we stay skeptics — of new wonder drugs, of 200-slide PowerPoints, of the well-rehearsed symptoms and our own too-smooth conclusions.

Skepticism isn’t a character flaw. It’s the pulse of good medicine.

And if we stop being skeptics?

We stop being safe.

Stay Unsure

—DW