Saturday, November 1, 2008

Why the Rich and Powerful Might Get Substandard Medical Care

Slate just ran a great article written by two distinguished emergency physicians who make the case that extra vigilant medical care may not simply fail to improve health, but may actually harm it. The piece is well-written, and strewn with some very insightful points. 

I'm no hypochondriac, but my doctor has always brushed off most complaints I present to her. She rarely even orders tests. A few years ago, just when I was about to deem her callous, she said something interesting. In response to whatever hazy symptom I was reporting, she told me "Look, I could test you to see whether you have a brain tumor, but what will probably happen is they'll find no tumor but something else will be noticed that will call for lots more tests, and, inevitably, procedures. I try to keep my patients the hell out of the machine so it doesn't kill them." Such bluntness doesn't play well with many patients, but I appreciated the bracing slap of reality. 

"Modern" medicine is, in many ways, barely less primitive than the good old days of leeches and humors. It's an imprecise art where tests, much less treatments, are not without risk, and even the most benign procedures carry a small possibility of doing grievous harm. And once the machine swallows you and starts finding the slightest indication of problems - any problems (which, of course, it will), no doctor will ever pull you back out again. Imagine the lawsuit if you did turn out to have a brain tumor...and some test result nebulously hinted in that direction?

Of course, when you need doctors, you need doctors. And in those times, say the authors of this article (though not in these words), it's best to shoot straight through the center of the machine, following as closely as you can the tire tracks of the vast majority of patients who've been through before you. 

1 comment:

pat said...

I've been on a medical adventure for the last 6 months or so. I'm now on a first name basis with three new "ologists". (They call me by my first time, I call them Dr. So and So! ) When one of them suggested a "full body PET scan", I said, "If you look that closely at a 70 year old body, you're going to find something that requires further investigation." He said we'd cross that bridge when we came to it, and of course we came to it. When an invasive procedure was considered though, we managed to try an alternative tack first. I had no such procedures. I WAS lucky to find doctors who listened. A lot of it is a crap shoot, I think.

I'm the one who lobbied for this medical circus, but only after my problem of many years had begun to affect the way I lived my life. I was ready. It's turned out ok so far. I feel fortunate, though, not to be rich or famous!

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