Tower of Hanoi | Resolution

The agreement

(Fictional narrative by the doctor)

James Fleck, MD, PhD & João A de Andrade, MD

Anticancerweb 20 (03), 2019

Theophilus used to see life as a mathematical equation. His health care had always been based on the results of laboratory tests, reinforcing a distorted view that health was dictated by numbers. Suddenly, a blood test showed a high PSA level, which could be associated with either malignant or benign diseases. He was surprised by what he perceived as an unacceptable inconsistency and became very disappointed with medicine. Fortunately, he opened a line of communication with the doctor, asking objective questions, trying to understand the process of decision-making in Medicine.

A real dispute between two different perceptions of the world ensued. Theophilus proposed a mathematical puzzle that required a recursive algorithm to be solved. In turn, the doctor realized that he needed to make Theophilus understand the process of medical decision making and demanded that he took a tutorial. Both were committed to their tasks and delayed any further discussions for 48 hours. The gap would be essential for mutual understanding and would not delay care.

The double challenge helped to improve their communication.

The physician entered the world of algorithms that is one of the foundations of the exact sciences. Theophilus, on the other hand, came to understand Medicine as a science of probabilities, in which an interdisciplinary team of professionals takes into consideration the best available evidence to develop plans of care.

What started as a dispute of sorts, turned into a playful activity. In due time, both realized that there were significant areas of overlap and that there was mutual commitment to achieving the best possible results. 

Gradually, mutual understanding and appreciation led to a level of equality in their relationship that greatly enhanced trust and communication. 

Patient and physician joined forces and both contributed to a good outcome!

Reference:

Image: Tower of Hanoi - Resolution - The Agreement: Image created by Gemini [Internet]. Mountain View (CA): Google LLC; 2026 [cited 2026 Jun 21]

*       Attention: The story 1 will be published sequentially from the PLOT 1 to the PLOT 6, however it will appear backwards. So, you will always see the most recent publication. Just browse in numbered pages located at the bottom of the homepage and start to read the story 1 from the beginning. 

Authors Info & Affiliations:

James Fleck, MD, PhD: Full Professor of Clinical Oncology at the Federal University of Rio Grande do Sul, RS, Brazil (www.jamesfleck.com)

Joao A. de Andrade, MD: Professor of Medicine and Chief Medical Officer, Vanderbilt Lung Institute, Vanderbilt University Medical Center, Nashville, TN – USA (Associate Editor)

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