Monday, August 19, 2013

Girls, Fast Cars, And Healthcare

It wasn't that I was so enamored with the girl herself. But as an awkward teenager, when a member of the opposite sex takes an interest, you tend to notice. We had gone on a couple of dates; spent some time together. So it took milliseconds to accept the invitation to join her and a friend for a ride in her new white Volkswagen Jetta. I slid into the back, and tried to nonchalantly fasten the seat belt. She hopped into the drivers seat with her best friend by her side.

Moments later, we were off.

The radio blared and the windows were open. My hair flew spastically in a multitude of directions. I patted the wayward tendrils and keened forward to listen. The conversation in front was lost in the rhythmic trance of radio waves. Expecting the joy ride to be over soon, I held tightly to my seat cushion as the car swerved onto Lake Shore Drive.

The rush of air was just enough to totally ablate the wild and carefree screams of the young girls in the front. Picturing them now with animated but mute faces would surely give the pair heartburn to know that this was my lasting, silly impression. I watched with slight horror as the odometer began to climb.

40, 50, 75, 100mph

We weaved back and forth through traffic. I closed my eyes tightly as the near misses became more near and less misses. I braced myself for the imagined impact. With relief the car began to slow and pull over to the right. The music was abruptly stopped, and the sound of approaching sirens filled the air. The policeman sauntered out of the squad car, and rested his elbow on the open driver's seat window. He looked at the two crimson faces in the front, then smirked at my pale white facade.

Her license was suspended for a year.

As I grew older and more confident, I developed the ability to speak up and not get myself into such situations. But as a hormonal teenager, there was definite gain in remaining silent: being cool in front of the object of my affection.

Unfortunately, as adults, we are confronted with many similarly confusing and difficult situations. Being a doctor, my patients often ask for tests or treatments that I don't feel comfortable dispensing. Every day I am approached for antibiotics, narcotics, and cat scans, usually in the absence of medically reasonable indications.

And like the teenager, there are many gains to being silent and acquiescing. Happier patients refer their friends. Happy patients rarely sue their doctor. Happy patients score their physicians better on quality surveys.

Yet studies are beginning to show that contented patients cost our healthcare system more, and suffer greater morbidity and mortality.

I'm all for shared decision making. When reasonable options exist (including declining care), I believe our patients should be fully informed. But some in the ranks of healthcare reform opine that patients should always be the driver of care. They say that a well informed patient can make the right decision even if it is deemed by the physician as unnecessary or even harmful.

To me, that sounds alot like getting in the passenger seat of a car with a sixteen year old girl for a 100mph joy ride down Lake Shore Drive. It may sound appealing at first.

But in the end it's downright dangerous.


CTBerg said...

Good post on timely topics, Jordan. It seems to me, just as patients are being encouraged to exercise "informed refusal" with doctors who might overtreat, MDs should attempt to invoke an informed refusal (while explaining risks vs. benefits) when patients request over-testing (i.e. Some MDs could push back more than they do).

But I dont think there can be a blanket answer since there will always be the potential for unreasonable people on either side of the table.

Anonymous said...

Like the above post. Here's the problem, what happens when a doc doesn't test enough? I've had that happen. I have an urgent care center that has seen me enough to know that I've been right on a lot of things. We have a long history. I got an internist who doesn't believe me, things were all in my head, and sure enough I turn up with issues less than 2 weeks after I got chewed for everything being fine. Then on top of that, the testing that my doc didn't do and I asked him for (based on my past history), showed problems, and stuff that was 'well we'll check one thing' was bad. I think that there needs to be a bit of judgment call on the person asking. I only will give my doc, and read, medical peer reviewed literature. I'm a PubMed sort of person. I can see it for others who want an MRI because their arm is sore, but when you have over a decade of issues and medical literature behind you, and the doc doesn't get it, what do you then? I'm not into suing people, I just want them to help me because what might be working for one person, may not be good for me.

older + wiser said...

I think the concept of "less is more" entails a major cultural shift in how we view health care, and learning to think differently isn't easy for either patients or physicians.

FWIW, many patients do appreciate it when the doctor is judicious about ordering tests or prescriptions. The last time I saw my doctor, his advice for managing insomnia and stress was not to prescribe anti-anxiety meds or sleeping pills but to make some lifestyle changes. Although this is easier said than done, I think it's the right approach, and we had a really good, positive discussion about it.

For this to happen, though, doctors need to think holistically and consider everything that may be going on in the patient's life. And patients have to keep an open mind and consider all the evidence. This is more likely to be accomplished within a relationship that is trusting and has been allowed to develop over time, and when decisions are mutually agreed on.

I fear we have become an instant-gratification society that wants results NOW and is quick to bash when things are less than perfect. Not sure how to fix that. :(