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:
- People get sick; it’s inevitable, so stop the blame.
- 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?
- 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?
- At the same time, evaluate the impact of the condition on your quality of life.
- Any significant risk related to any treatment should be carefully evaluated.
- 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