Suck it Up America

I did not write this. But I should have…

Sunday Forum: Suck it up, America
We have become a nation of whining hypochondriacs, and the only way to fix a broken health-care system is for all of us to get a grip, says DR. THOMAS A. DOYLE
Sunday, October 11, 2009
Pittsburgh Post-Gazette

Emergency departments are distilleries that boil complex blends of trauma, stress and emotion down to the essence of immediacy: What needs to be done, right now, to fix the problem. Working the past 20 years in such environments has shown me with great clarity what is wrong (and right) with our nation’s medical system.

It’s obvious to me that despite all the furor and rancor, what is being debated in Washington currently is not health-care reform. It’s only health-care insurance reform. It addresses the undeniably important issues of who is going to pay and how, but completely misses the point of why.

Health care costs too much in our country because we deliver too much health care. We deliver too much because we demand too much. And we demand it for all the wrong reasons. We’re turning into a nation of anxious wimps.

I still love my job; very few things are as emotionally rewarding as relieving true pain and suffering, sharing compassionate care and actually saving lives. Illness and injury will always require the best efforts our medical system can provide. But emergency departments nationwide are being overwhelmed by the non-emergent, and doctors in general are asked to treat what doesn’t need treatment.

In a single night I had patients come in to our emergency department, most brought by ambulance, for the following complaints: I smoked marijuana and got dizzy; I got stung by a bee and it hurts; I got drunk and have a hangover; I sat out in the sun and got sunburn; I ate Mexican food and threw up; I picked my nose and it bled, but now it stopped; I just had sex and want to know if I’m pregnant.

Since all my colleagues and I have worked our shifts while suffering from worse symptoms than these (well, not the marijuana, I hope), we have understandably lost some of our natural empathy for such patients. When working with a cold, flu or headache, I often feel I am like one of those cute little animal signs in amusement parks that say “you must be taller than me to ride this ride” only mine should read “you must be sicker than me to come to our emergency department.” You’d be surprised how many patients wouldn’t qualify.

At a time when we have an unprecedented obsession with health (Dr. Oz, “The Doctors,” Oprah and a host of daytime talk shows make the smallest issues seem like apocalyptic pandemics) we have substandard national wellness. This is largely because the media focuses on the exotic and the sensational and ignores the mundane.

Our society has warped our perception of true risk. We are taught to fear vaccinations, mold, shark attacks, airplanes and breast implants when we really should worry about smoking, drug abuse, obesity, cars and basic hygiene. If you go by pharmaceutical advertisement budgets, our most critical health needs are to have sex and fall asleep.

Somehow we have developed an expectation that our health should always be perfect, and if it isn’t, there should be a pill to fix it. With every ache and sniffle we run to the doctor or purchase useless quackery such as the dietary supplement Airborne or homeopathic cures (to the tune of tens of billions of dollars a year). We demand unnecessary diagnostic testing, narcotics for bruises and sprains, antibiotics for our viruses (which do absolutely no good). And due to time constraints on physicians, fear of lawsuits and the pressure to keep patients satisfied, we usually get them.

Yet the great secret of medicine is that almost everything we see will get better (or worse) no matter how we treat it. Usually better.

The human body is exquisitely talented at healing. If bodies didn’t heal by themselves, we’d be up the creek. Even in an intensive care unit, with our most advanced techniques applied, all we’re really doing is optimizing the conditions under which natural healing can occur. We give oxygen and fluids in the right proportions, raise or lower the blood pressure as needed and allow the natural healing mechanisms time to do their work. It’s as if you could put your car in the service garage, make sure you give it plenty of gas, oil and brake fluid and that transmission should fix itself in no time.

The bottom line is that most conditions are self-limited. This doesn’t mesh well with our immediate-gratification, instant-action society. But usually that bronchitis or back ache or poison ivy or stomach flu just needs time to get better. Take two aspirin and call me in the morning wasn’t your doctor being lazy in the middle of the night; it was sound medical practice. As a wise pediatrician colleague of mine once told me, “Our best medicines are Tincture of Time and Elixir of Neglect.” Taking drugs for things that go away on their own is rarely helpful and often harmful.

We’ve become a nation of hypochondriacs. Every sneeze is swine flu, every headache a tumor. And at great expense, we deliver fantastically prompt, thorough and largely unnecessary care.

There is tremendous financial pressure on physicians to keep patients happy. But unlike business, in medicine the customer isn’t always right. Sometimes a doctor needs to show tough love and deny patients the quick fix.

A good physician needs to have the guts to stand up to people and tell them that their baby gets ear infections because they smoke cigarettes. That it’s time to admit they are alcoholics. That they need to suck it up and deal with discomfort because narcotics will just make everything worse. That what’s really wrong with them is that they are just too damned fat. Unfortunately, this type of advice rarely leads to high patient satisfaction scores.

Modern medicine is a blessing which improves all our lives. But until we start educating the general populace about what really affects health and what a doctor is capable (and more importantly, incapable) of fixing, we will continue to waste a large portion of our health-care dollar on treatments which just don’t make any difference.

Anita Dufalla/Post-Gazette

Dr. Thomas A. Doyle is a specialist in emergency medicine who practices in Sewickley (tomdoy@aol.com). This is an excerpt from a book he is writing called “Suck It Up, America: The Tough Choices Needed for Real Health-Care Reform.”

Read more: http://www.post-gazette.com/pg/09284/1004304-109.stm#ixzz0TgtnEINR

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as anyone who’s ever seen a 12 year old wreck his bike into a barbed wire fence at 25 mph and not feel the need to cry until he realizes no one will wait up for him to hear his story, they are nearly invincible. My point is, that children are not real, they are simply a developing organism which will someday turn into a jumbled twine of conscious thought, buried emotions, and ever-mounting divorce papers

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I’ll take mine plain…

He was a funny little man. The black leather chaps and jacket almost hung off his body even though I’m sure they were a size small. On his way to the Sturgis Motorcycle rally he had veered off the road while admiring the view and slid on the gravel at the side of the road. His left thumb took all the force and rapidly popped out of joint. While he wasn’t in that much pain, there was no way he could drive his motorcycle twenty miles to the nearest hospital.

As soon as he climbed out of the ambulance,  you couldn’t help but laugh. He had a smile from ear to ear and despite his bike touring vacation being potentially ruined by a ride ending injury, he was all about enjoying himself in the moment, no worries about the past or future.  But if appearances were everything, he might not be someone you’d want to admit you were friends with… or at least not take home to mother.

What would otherwise be called a sunshine smile revealed yellowed nubs of teeth barely long enough to chew a piece of bread.  When he laughed, a raspy smokey breath of air filled the space in front of him…you could almost see the years of cigarette smoke that had built  up in  his lungs.

His friends were equally as happy and easy going. I really can’t explain why this little man was so fascinating to me. I guess because in my role as an ER doc, I get to see all sides of people. Normally I wouldn’t have given this man and his friends the time of day. I mean, based on appearances alone, he was kind of gross.  And if you judged a man by the stickers on his black motorcycle skull cap, well, he was downright disgusting.  When he went to xray for his thumb, I took photos of the bumper stickers on his helmet.

“I was born with nothing, and still have plenty of it left”

“I’m looking for the perfect woman, a nymphomaniac who owns a liquor store”

“Could you drive any better if that phone was up your a**”

“I’ll be sober tomorrow, but you’ll still be ugly”

And perhaps the most disgusting of al and yet somehow amusing…

“9 out of 10 women are battered, but I’m still eatin’ mine plain”

After he returned from x-ray, he asked if he could go outside and have a cigarette while he waited for the results. So he and his buddies headed out to the ambulance bay and smoked and laughed and laughed and smoked.  I guess what was really intersting was that despite all the messages he carried around on his helmet and the tough persona he emulated in the motorcycle outfit and mannerisms, the whole group of them was just downright nice.

They were polite and thankful and optimistic about the rest of their trip to Sturgis. I placed a splint on his left hand, and he hopped on the back of his buddy’s motorcycle and they rode off into the mountains together, both of them wearing helmets even though not required by law.

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While tragic, it made me realize how much time I spend idle and unfocused. I’ve been far more optimistic thinking to myself, What would Mikey do right now?  He wasn’t one to waste time with anything…always planning his next adventure.

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I worked the first four days upon arriving here, so it wasn’t until yesterday that I had a chance to go out for a ride.  I was all ready to hit the road when I looked at the fork on my bike, and it was a bit crooked. I pushed down and uh oh…Fork screwed. Headset broken. Head tube cracked. Damn.  On the way out, i had run into a metal “warning” bar while going through a drive through and heard an awful noise on the roof.   The mountain bike rolled backward over it’s front wheel holder and was simply thrown free of the impact with no frame damage to the bike that I can tell.  Teh road bike was not so lucky as the forks were securely locked into the fork mount carrier.

Damn.

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I try to leave them as fully informed as possible.

If scientific research shows that it is safer to pull kids from a same day game for any evidence of a concussion, who are the sideline docs and coaches to say that this policy is unsafe?  All we can do is educate.  The arguments against this policy are one reason why I do not envy sideline docs, because my decision would be to bench every kid that got hit in the head until further evaluation cuold take place. It’s just not worth the risk.

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I have used Imitrex with great success since my 2nd year of medical school.  Typically a 50 mg tablet relieves my headache with nearly 100% effectiveness within about 45 minutes to an hour with no significant side effects.  The first few times I took it, my muscles felt a little bit “wierd”, but otherwise no real problems.

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