Simplicity is the Ultimate Sophistication in Medicine

Residency Reflections #12

Author

Jared Dashevsky, MD
February 11, 2025 • Estimated Reading Time: 8 minutes

RESIDENCY REFLECTIONS

Simplicity is the Ultimate Sophistication in Medicine

Last year, I came across a quote in the Steve Jobs biography by Walter Isaacson:

Simplicity is the ultimate sophistication.

This simplicity, however, doesn’t come from ignoring complexity—it comes from conquering it.

When I first read this quote, I thought about how Apple products feel intuitive. You don’t need a manual to use an iPhone because the complexity is hidden under the hood. That’s exactly how medicine should be—complicated beneath the surface but simple in execution. The best doctors make it look effortless, not because medicine is easy, but because they’ve mastered its complexity.

After all, medicine is inherently complex—but simplicity brings clarity.

Take this one-liner, which we see every day:

56-year-old male w/ PMHx of afib (on Eliquis), HFrEF (LVEF 35%), T2DM (A1c 10%, on insulin) c/b ESRD (on HD MWF), severe persistent asthma (h/o intubation), presenting w/ SOB and chest pain, found to be flu positive.

It’s overwhelming. Where do you even start?

If you don’t master the complexity, you risk getting lost in it—focusing on the wrong problem, ordering unnecessary tests, overcomplicating the plan, or missing the real issue. But if you truly understand the fundamentals (which come with training), you can filter out the noise and focus on what matters.

The Patient Story

Taking an admission history often feels like putting together a jigsaw puzzle—except half the pieces are missing, and the patient keeps changing the picture.

  • Symptoms started “a few days ago… no, actually last week… well, maybe a month ago.”

  • Medications? “I take them… sometimes.”

  • Prior surgeries? “Something in the past, I think.”

The challenge is making sense of the mess.

If you simply document everything without structure (which is what I did in medical school), you end up with a convoluted HPI that doesn’t clarify the real issue. But if you truly understand their story, you can distill it into a clear, concise timeline:

56-year-old male with history of HFrEF (LVEF 35%), ESRD (on HD MWF), and asthma, presenting with 3 days of worsening SOB. Symptoms started with congestion and fatigue, progressed to dyspnea at rest, and worsened overnight. No fevers. On exam, hypoxic to 88% on RA. Flu positive.

Now, instead of a chaotic history, you have a simple, structured, and actionable timeline. The best clinicians aren’t the ones who write the longest notes. They’re the ones who truly understand the story and can communicate it simply and effectively. That’s just my take, though.

The Treatment Plan

So then, what about this patient’s treatment plan? He has so many conditions—serious ones, too.

Instead of treating everything at once, I’ve learned to focus on what’s actively changing and what needs immediate attention:

#SOB? Flu positive → Tamiflu (renally dosed), HFNC, chest PT, Duonebs q6hr PRN

Everything else? Chronic conditions that remain stable → Continue current treatment.

It’s easy to get caught up in every comorbidity, but training teaches you to recognize what truly matters at the moment.

How Expertise Evolves

Early in training, you’re drowning in details. By residency, you learn to separate signal from noise. By fellowship, you anticipate problems before they arise. And by the time you’re an attending, you make complex decisions look easy—not because they are, but because you’ve mastered the nuances beneath the surface.

Simplicity in medicine is about mastering the complexities so well that you can cut through the noise and focus on what truly matters.

Steve Jobs applied this philosophy to design. We apply it to patient care, clinical decision-making, and lifelong learning in medicine.

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