Health Rule: Ask About the Risk

 

Health Rule: Ask About the Risk

Have your questions ready. You deserve time and answers.

A New Year is a good time to consider New Theories. Dr. Rob Lamberts recently shared a fascinating one in his post entitled: Healthcare Is Not About Achieving Wellness in People. It caught my attention, wellness being a subject I frequently write about. Lamberts states: I have moved my thinking…toward the bigger picture. I am focusing less on problems and more on risk. I am focusing less on solutions, and more on responsibility. Considering recent reports that after  common medical procedures two children are now brain dead, Dr. Lamberts’ argument is worth examining. Yes, bottom line, responsibility should lie with the physician—DO NO HARM. But like Dr. Lamberts, clients and caregivers of clients should be asking and thinking about risk too.

We live in a world of problems and in our world there must be a solution to every problem. As Lamberts believes we have a general concept of what health is and when we depart from that norm in any way, we think we are sick.

I remember learning in nursing school that a fever in a pediatric patient is not necessarily something to treat. The body uses fever to fight off infection. Lamberts questions the necessity for always intervening with medicine: The reality is…that simply by allowing their T-cells to do their job, they will get better 99.9% of the time without any intervention. In fact, it is reasonable to suggest that this may even be the equivalent of exercise for their immune system. Studies suggest that infants in daycare who are exposed to the germ cesspool that is a daycare center are actually less likely to get sick when they are older than children who are kept at home. It may actually be good when people get sick.

Maybe the fact that many of us have a medicine cabinet stocked with over-the-counter drugs indicates that we buy into the disease/cure mindset—if our bodies don’t provide a certain norm, we are sick and sick is bad.

The following is a shortened list of some of the elements or arguments of Dr. Lamberts’ theory, with my input added:

1. Lamberts: a problem requires blame. What did I do wrong to get sick? The real cause? We are human and humans get sick.

2. Lamberts: routine testing doesn’t prolong life; often there is no good clinical motivation to routinely test, but there is a huge economic one. Me: this is confusing and I see both sides of this—a friend whose colon was nicked during a routine colonoscopy and almost died versus the statistics that cancer of the colon can spread throughout the body, causing death, if routine testing is not done.

3. Lamberts: our medical system is obsessed with definitions like obesity, which now has a diagnosis code that allows for bariatric surgery and medication. And what about attention deficit disorder, Is it a problem (disease) or is it simply an immature kid or absent-minded adult? These types of debates will only increase as long as we keep the disease/cure mindset. Me: we certainly have medicated children who probably do not need to be medicated.

4. Lamberts: we often look for solutions to physical developments that are not problems. When doctors call a loose cough bronchitis, it justifies writing a script for antibiotics. Me: it is generally known that antibiotics are losing their ability to fight serious illnesses like C-Difficile because they are so over-used.

5. Lamberts: interventions can cause their own problems like nicking a colon; and abnormal lab tests can lead to more lab tests and unnecessary worry. Me: historically this has been the case with false positives related to the maternal serum alpha fetoprotein (MSAFP) screening. Its accuracy depends on gestational dating; when results are high doctors often recommend further testing like an amniocentesis.

6. Lamberts: because of the disease/cure mindset, we can easily be duped by all the “cures” out there. Example: “bathe your feet in this water and when the water turns color the toxins are removed from your body.” Me: he’s right. Just search the net and you will find people selling things that couldn’t possibly solve your so-called health problem.

7. Lamberts: many patients avoid getting care because they have bought into society’s practice of pointing a finger of blame for every problem, and so are ashamed of their blood pressure, diabetes, or their child’s asthma. Others are harmed by providers (both in my profession and outside of it) who promise miracle cures. Still others spend huge sums of money striving for the generally elusive (and always temporary) goal of wellness. Me: excellent points.

If we are going to make ask about risk a new health rule, consider the following:

  1. People get sick; it’s inevitable, so stop the blame.
  2. When you develop a symptom, notice a change in how your body works, ask yourself: what is the risk, what is the worst that can happen and how likely is it?
  3. Always evaluate the risk of the intervention against the condition. What does this (lab test, med, procedure) do to lower the risk of the condition? Could it cause more harm?
  4. At the same time, evaluate the impact of the condition on your quality of life.
  5. Any significant risk related to any treatment should be carefully evaluated.
  6. When considering an elective procedure that possibly could reduce risk in a healthy person, consider the risk of that procedure.

Dr. Edwin Leap, an emergency physician, comes at aspects of this discussion from a different angle. He argues in his post, We Don’t Really Get to Die of Old Age, that it’s a misnomer to say that the elderly die of old age. And he encourages caregivers to consider the following when their elderly loved one is sent to the ER:

1) What do I want to have done?

2) What outcome do I hope to see in my family member?

3) What am I willing to put that person through?

4) What would they realistically want if they could say?

These are very important questions to balance with Lamberts’ theories. Death is part of life. Not every problem has a solution that includes life. Sometimes letting a person die is the solution. Leap states: …I’m not advocating “mercy killing” or anything as nefarious  as that. I want everyone to have as much time, and as much quality of life, as possible.  But we need to be merciful and realistic. And even those working in nursing home facilities need to be practical. A nurse once told me that she wanted an elderly patient taken to the ER for pneumonia, against her family’s wishes. I asked her, “How do you want to die?” Her answer was telling: “Why, of old age, of course!”

But the human body is fallible and we all die of something. Dignity and comfort should be our first thoughts when we must make decisions for an elderly loved one who cannot. Avoid interventions and think of the health rule: ask about the risk.

Read all of Dr. Lamberts’ post here:

Read all of Dr. Leap’s post here.

Thanks to Google Images

Health Rule: Ask About the Risk

 

 

6 thoughts on “Health Rule: Ask About the Risk

  1. There are so many excellent ideas here. I applaud the idea that we need to take care of our bodies, that we need to be responsible as well as our doctors. However, I am somewhat off put by the idea that there is too much medicine out there or that we should let our bodies take their natural course. The fact is that modern medicine and the amazing technology we have today have allowed us to live better, higher quality lives. Doctors and scientists are devoted to finding ways to make our lives better, whether it be through medication, preventative measures and testing or actual cures. Think of a disease such as polio… less than 60 years ago people were crippled by it. A friend of mine growing up had a father who suffered polio as a child. I knew this friend when we were about 4 years old, so his father at most was maybe 35-40… but his father seemed so old. He walked with a limp and had a huge brace on his leg, he walked slowly and he went to work everyday but you could tell he had a very hard time walking. However, because of the amazing advances of medicine, his son never had to even worry about getting polio. His child and future grandchildren wouldn’t even know what polio was if their Dad/Grandpa hadn’t contracted it. I think that, yes, our bodies are showing resistance to antibiotics, however, without those antibiotics people would die from things such as bronchitis and pneumonia. Yes, I realize, in some cases they do still die from these but the instances are far less. Infant mortality is so much less than it used to be because of antibiotics, because of advances in medicine that allow doctors to be aware of situations before they happen. Yes, at times there are false positives, at times people have other things happen, such as the nicked colon, however if that test had reveled colon cancer, in an early stage than the nicked colon wouldn’t have been such a big deal…
    If we go backwards in our thinking, letting the body do whatever it wants, we will end up back in a time when medicine didn’t help people. When doctors gave liquor to ease a cough and leeches to get rid of an infection. We cannot always have a perfect outcome, which is a correct suggestion, however, we cannot simply give up on medicine or let things run their course without getting advisement. We do need to question our doctors more, we do need to understand the risks more.
    The young girl who is brain dead after surgery for sleep apnea is an excellent case. The surgery was to correct a defect that is known to cause death, sleep apnea is also known to cause cardiac issues. The young girl went into cardiac arrest after the surgery and what I wonder most, is why/how did this happen? Sleep apnea and cardiac issues go hand in hand, so was she at greater risk? Did the family understand the risk? Couldn’t the CPAP machine have helped her? The sleep apnea surgery is already known to be risky and only works in 20% of cases. So I have to wonder, did her family know all that? Did they know enough to question it? Why would doctors have allowed that kind of risk on a young girl? That of course is where modern medicine fails. In this case, the poor girl is confirmed brain dead and her family is keeping her alive on a ventilator… on one hand I understand the family’s passion in keeping her alive, her heart is beating, on the other side, the medical community has declared her brain dead. Of course this is the same medical community that allowed this risky surgery in the first place so how do you trust them?
    Overall, I think medical advancements are very important. I think finding ways to live better and live longer are key to the survival of our species. Going backwards in medicine or not accepting advancements that make life better are not the way to fuel medical technology. However, being more involved in your own care and recognizing that YOU have a part in your body combined with preventative measures and medical advancements would be the most effective path we can take.
    Thank you for sharing this important article and your own ideas!

    • Dear Natalie,
      I think Dr. Lamberts presents some important ideas. If you elect to have facial plastic surgery, what are the risks? If you allow a surgeon to do exploratory work, what are the risks? I think that’s what he is asking. We do overuse antibiotics. We do need to evaluate the reasonableness of certain tests. John had radiation when an IV of a biologic drug would have solved the problem. STUDY AND EVALUATE THE RISK, that’s what he is saying. I am all for vaccinations: http://boomerhighway.org/why-jenny-mccarthy-is-selfish/, so I agree on your polio argument. As for the recent two cases of brain death, one was a tonsillectomy and the other a dental procedure on a 3 year old. There had to be other risks that were not evaluated. Otherwise, it makes no sense.
      Thanks for your comment. I present different ideas on my blog, because we need to evaluate how we utilize medicine to the best effect–so we do no harm. Beth

  2. The recent brain death from a tonsillectomy wasn’t actually for a problem with the girl’s tonsils. They did the tonsillectomy to try and help a sleep apnea problem. I had to dig through some of the basic news articles on that story to find that information. I was actually shocked that the doctor and parents had allowed this surgery to take place. The recovery on it is brutal and the risks are high, as seen with the young girl now being brain dead. That’s where I believe not enough questions were asked and these poor people are now left to live with the decision of allowing this surgery to take place. I understand many sides of what Lambert is trying to state, just from a personal perspective having dealt with SEVERE medical issues my entire life, I am strong believer in medicine and trying to advance it. In trying to do all you can to make life better. I get frequent colds. I have for my entire life. Without my OTC drugs for my sinus issues I wouldn’t be able to get out of bed and go to work…so it’s cyclic, I take Vit C, eat right, wash hands etc… but my body still breaks down every 2 weeks or so but I am not allowed that kind of time off work so I have to find ways to manage the headaches, cough and nose/sinus issues. OTC meds help me do this.
    Personally, I hope someday our medicine advances to that of Star Trek era where a single flash with the doctor’s laser will ‘cure’ us!

    • You are actually doing some of the things that Lamberts is suggesting: hand wishing and a proper diet that can ward off colds and the
      visit to the doctor. I don’t mean to take his side all the time. I tried to show that I don’t totally GET his argument, but it’s a good one to consider. And in another post, a pediatrician used the argument of RISK to defend vaccinations. Nothing is risk-proof. Driving your child to the store has statistical dangers and those are probably higher than the argumens NOT TO VACCINATE. Beth

  3. I totally understand your points and appreciate the article in many aspects. Risk is always the main concern of anything in life… it’s something many people don’t think twice about though. I talk to people about their healthcare and they are so uninformed and will blindly follow doctor’s orders without wondering if there’s a better way or if possibly they should get another doctor’s opinions, especially when it appears as if that doctor is being lax in treatment options, causes etc…
    I admit being a mother in today’s age, I gave long thought to whether to vaccinate or not. I actually opted to not vaccinate Grace for the mumps vaccine until after she was 5 years old because of the studies linking diabetes and mumps vaccine when the child was younger than 5 for first vaccination. The risk of diabetes is already so great in her being that I and her father have it, that I decided to wait before adding any further risk. Since she wasn’t in day care or school until she was older it wasn’t a large risk of her getting the mumps or giving it. At any rate though she did have all the other vaccines and we still have all kinds of issues with her health, respiratory issues. I have several close friends that have an autistic child and the guilt they feel at having had their child vaccinated is astounding. They said they will wonder forever what their child’s would have been like if they hadn’t taken the risk. Even with the studies suggesting there is no link, they still beat themselves up. I know that if Grace contracts diabetes I will feel terrible and I will blame myself but I also know she is a delightful child, that she is the light of my life and we will survive and that there is always a risk with healthcare, nothing is foolproof…

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