Every patient is unique, made up of their own combination of genes, good bacteria, and pathogens that have been acquired from conception through life. Every patient has unique underlying conditions affecting the body as a whole or particular organ systems; and unique combinations of immortal pathogens and immune responses to those pathogens, over time.
Medical training and standards of care can be very rigid, and very specialized, determined by specialty, body part, and disease. Rigid standards of care may be self-imposed, imposed through peer review and training, and/or enforced by employers and insurers. Rigid standards may conflict with the unique needs of the patient, and in some situations be insufficient or ineffective in treating the patient.
Medical judgment must look beyond rigid standards of care, and ponder new solutions. A more extensive medical history is necessary, from the patient and all family members, including non-genetic relatives and pets; and a greater emphasis on diagnosis of infectious pathogens is needed, to understand the uniqueness of each patient and to formulate unique treatment options. What has always been done may not be appropriate treatment for every patient or in every situation.