Good MedicineDr Stephanie Aron · The Village GP

Before We Begin

When something goes wrong with how we feel, most of us want to know why. We want a name for it, a cause, a clear path back to feeling well. This is a completely reasonable thing to want, and I take it seriously every time someone sits across from me and asks.

There is a version of medicine that has been built around the promise that your body always has a single root cause for every problem, and that with enough testing, that cause can be found and corrected. It's a compelling promise. It sounds thorough, rigorous, and reassuring.

But the promise itself misunderstands how health actually works. And I think you deserve to hear about that, so that what we do together can be built on something more honest.

Two Kinds of Problems

If your kitchen tap is dripping, there's a clear cause — a worn washer, a faulty valve — and there's a fix. A plumber finds the broken part, replaces it, and the drip stops. One cause, one solution.

Now think about a different kind of problem. A child who has stopped sleeping well. A friendship that's slowly drifted. These things don't have a single broken part. They have dozens of threads — history, stress, habit, circumstance, timing — and they ask for a completely different kind of thinking.

Most of what brings people to see me belongs to this second category. These aren't mechanical faults waiting to be identified. They're the result of many systems interacting, and they rarely trace back to one origin.

The Body as a Garden

There's an understanding of the body that most experienced doctors carry, often without quite putting it into words. Patients who've lived with chronic conditions sometimes arrive at it too, after a long road of tests that didn't quite explain things.

The human body works far more like a garden than like a machine. Health isn't a fixed state to be engineered — it's something that emerges from the interactions between many systems: immune, hormonal, nervous, digestive, psychological, social. What happens in one ripples through others in ways that can't always be predicted.

This means health rarely improves by attacking a single cause head-on. And it means that some things — genetics, age, life history — are genuinely fixed. They aren't problems to eliminate. They're the soil you're working with.

On Uncertainty

Medicine doesn't always deliver certainty. It delivers probability — likelihoods, not guarantees. When something is wrong with our health, certainty is exactly what we're looking for. But for many of the conditions that most affect people's quality of life, there isn't a single cause to find. There's a web of contributing factors that shift with time and context, and that can only be understood through careful, patient observation.

In people who aren't acutely unwell, running a wide panel of tests reliably turns up borderline results — values just outside the normal range, technically flagged but clinically meaningless. These findings create worry. They lead to more tests, referrals, sometimes procedures — often without any real improvement in how someone actually feels. The search for certainty can produce more uncertainty, not less.

This is why, before ordering any test, I try to ask not only what it might find, but what we would do with the result — and whether that would genuinely help this particular person.

What I Do Instead

None of this means doing less. It means matching the response to the actual nature of the problem.

When something is straightforward — an infection, a clear diagnosis — I act quickly and decisively. That's the dripping tap. But when the picture is more complex — when symptoms have persisted through multiple interventions, when several systems are interacting, when context and history matter as much as bloodwork — the approach needs to be different.

In practical terms, this means asking different kinds of questions. Not just "what is causing this?" but "what patterns can we notice over time?" Not "what does this test reveal?" but "if this result came back positive, would the next step actually help this particular person?" Not "how do we find the root cause?" but "What are all the factors that could be at play here?"

This isn't indecision. It's the only way to navigate a situation where cause and effect aren't straightforward. And it requires its own kind of honesty — the willingness to say that further investigation might add worry without adding benefit, and that the most useful thing I can do right now is pay attention, think clearly, and stay calm.