GOING FOR BROKE
Personal experiences often provide keen ways to learn. Let me share a couple of my own recent medical stories and then expand them to the larger world.
Seven years ago, I was painting a house off a tall but not well placed stepladder. Of a sudden, the ladder went one way and I the other. My RIGHT foot landed in a hole and my ankle was injured sufficiently for me to spend most of a month on the couch. I only ventured out for necessities. I did hobble around to load the dog into the pickup and drive out of town so Maggie could get some air and exercise. The painting season was over for that summer.
From time to time during those days, I would see my neighbor Loren at the back fence. On a number of occasions, he queried, “Do you think it’s broken?”
My consistent response was, “We will never know.” By late summer 2012, my recovery was complete and I was able to walk over 600 miles on a journey toward California.
History sometimes repeats itself. Late in August this year, I was doing a re-paint job on the trim for our Senior Center. It was the Senior Center and the Musselshell Masonic Lodge when I did it first time around ten years before.
I got so tired of seeing my paint work in such bad shape that I volunteered to redo the work. Late on a Friday afternoon ten weeks ago, I was up on an extension ladder finishing the trim on the big front window. The weather shifted quickly as an intermittent breeze developed. I told myself that I had a couple minutes to finish the corner.
That said, a huge Montana wind came up from the south. It threw me, ladder and paint for a loop onto the sidewalk. I landed powerfully on my LEFT heel and bounced off my left elbow.
A number of helpers appeared. I didn’t give them time to even suggest going to the hospital. There was neither blood nor obvious wound. Mary Beth brought her car around and helped me into the passenger seat. After driving to Elaine’s house and procuring crutches and a walker for me, she aided me as I hopped up the stairs to my apartment.
There I remained for over six weeks, hobbling and bouncing across my flat. People came to visit and help out in various ways. It was interesting to note that I had more visitors in those few weeks than I had had in the previous three years in my recent home.
Several visitors had to offer the refrain, “Did you break anything?”
And, I had to reply, “We will never know.”
To some I explained as I do now The Rest of the Story. You see, the modern world has given us Xrays and scans many times over. And, we have been trained and brainwashed to believe that there is something magical about having our “picture taken.”
Once shot, a physician or radiologist can “read” the film and have information to help attend our illness or injury. Sorry to say, in the vast — very vast — majority of cases the test and the reading are useless regardless of the expense. They often produce No Information. On other occasions Equivocal Information. On many other occasions Irrelevant Information — useful to the situation at hand.
The reader may think that his/her physician would not do tests unnecessarily and wastefully. But, that is far, far from the case. Physicians are taught to diagnose and treat and to believe in their expensive tests. They also are wary because of malpractice and “covering tracks” so as to error on the side of doing too much rather than too little.
At the same time, the public at large believes in blood tests and Xrays. Between the two sides of the equation, we have created an wealth of them. More and more each year.
There are thousands of blood tests by now. Many, many from which your doctor can choose. We are also in a period in which scanning devices are proliferating.
Some blood tests are relatively inexpensive. But, scans are where the money comes in these days. Whole businesses and buildings are built now serve customers who have been prescribed scans. In those cases, it is quite obvious that money runs the operation. In others, the tests bring plenty of income to clinics and hospitals. Regardless, the income is a major factor in the practice of modern medicine.
I am reminded of a conversation with a Physician Assistant who used to work at the local hospital. He mentioned his Hospital Administrator taking him aside one day and asking him why he didn’t order a scan (hundreds of dollars at a pop) on a certain patient. The P.A. simply responded, “Are you a physician?”
That was a none-too-subtle suggestion that the administrator was “out of his element.” Actually, the CEO was and was not “out of his element.” The Administrator’s element is keeping his facility open, signing checking, paying bills. Quality and sensibility of care often become lower in priority as costs increase constantly.
So, there is all too often an overriding Conflict of Interest in medical decisions. (I avoid the word care, because much of medicine is and has been for long times Business first, Care second or further down the list.)
Then, there is the other part. The belief and expectation among patients that doctors have tests to tell them how to proceed with their diagnosis and treatment. Patient expectations do have decided effects on how they fit in the system and how the system treats them.
Both physicians and patients might today benefit as I did years ago when Dr. Cheves Smythe spoke on rounds one morning when I was in training at St. Joseph Hospital in Houston, Texas. His presentation was one of the few highlights of my medical school career and is retold in detail in my book People Medicine.
For the moment, I will just share the punchlines of his teaching. Dr. Smythe told us physicians-in-training. He said, “Ninety percent of your information should come from history and physical examination. The other ten percent from tests, when they are deemed necessary.”
He went on to say, “Before you order a test or Xray, you should already have a pretty good idea of what the result will be. And … if you know what the report will read, you probably don’t have to order the test.” Well, how often is that the case in the present Day of Tests?
Wow! What wonderful words and insights. Unfortunately, they have been unrecognized by a large majority of physicians. Most patients would never let there imaginings turn in that direction.
Many years after I heard Dr. Smythe’s wise remarks, I discovered the following quotation from Dr. Tinsley Harrison, the famed editor of Harrison’s Textbook of Internal Medicine. Even from the 1950s, Harrison was disturbed about “the present-day tendency towards a five-minute history followed by a five-day barrage of special tests in the hope that the diagnostic rabbit may suddenly emerge from the laboratory hat.” How do you think he would feel today?
So, what has all that got to do with my ankles and “Going for Broke”?
Well, I agree with those wise physicians and treated myself accordingly when I had my injuries. I was not bleeding from the injuries and no bones were sticking out of my flesh. So, I figured to attend myself as well as a physician at a clinic or hospital would. I also had time and patience to let Nature do its work undisturbed. Some people don’t have the time. Then, they try to get the medical system to speed their healing. Which often doesn’t work.
Had I taken myself do a physician, I most certainly would have been faced with medical bills of at least $2000 on each incident. That because of protocols and fears for my well-being. Of course, the state of my wallet has much to do with my state of being.
We will never know whether I broke any bones because of either incident. I don’t call them accidents. Mishaps maybe. Accident suggests a happening without meaningful cause. Such was not the case in either incident. For anyone interested in that line of thinking, ask me personally and I will explain.
Be assured had I been attended by a medical provider, s/he would have been keen to find out “if anything is broken.” But, I must report to the reader that a broken bone does not prove a significant injury. Many fractures occur unrelated to trauma or symptoms. Many readers probably have experienced fractured bones and are totally unaware of them.
On the other hand, an injury without fracture can be more traumatic than one with even multiple fractures. Some people suffer massive injuries, yet no fractures. It is the black-and-blue effects, swelling, and limitation in movement secondary from injury which cause pain and discomfort. Bones do not contains nerves.
My friend Grocer Bob caught me walking with a limp to the Post Office in the latter days of my recent recovery. After greetings he asked, “Well, do you have intact sensation? Good circulation?” The answers were Yes. Bob figured I had things well in hand and knew the ropes, so to speak. He gave me a thumbs-up. Bob seemed to understand some of the more important things in such situations than many trained medical personnel who tend more to tests than to patients.
I needed no tests, Xrays, splints or casts. Nature just needed time to do its work. Intervention by physicians, however well-meaning, just would have “added insult to injury.”
William Osler, Father of American medicine, is known for remarking that, “Once the physician treats a patient’s ailment, the patient goes from having one problem to having two.” Actually, it may be far more than two. Depending on how many things the physician decides to prescribe.
“Going for Broke” through Xrays and testing were not what I needed and not what lots and lots of patients need. But, “Going for Broke” is an attitude of medical people and the general public have developed over the generations, especially since Xrays appeared 100 years ago.
But you ask, “Have Xrays not been useful in medical practice?” Surely they can be valuable in certain situations. But, we also might consult the wise physician named Robert Mendelsohn who wrote a generation ago that “the Xray machine is the most pervasive and most dangerous tool in
the doctor’s office.”
Xrays can be expensive and dangerous. Let us leave the “dangerous” for this essay and focus in the latter lines on the “expensive” part of the issue:
“Going for Broke” seems to this physician-writer to be the direction in which “universal health care” is leading us.
Many people recognize that the Medical System is already Broken. It has been for a long time. We can blame that on many things: insurance, malpractice, consumer expectations, etc.
Medicine, like other aspects of life, isn’t like it used to be when we were youngsters. It is more hurried, expensive, assembly-line, drug-powered. And, it has lost personal contact, interest, care and sympathy. It has become more business and less profession.
Now, it is in fashion to suggest that repairing medicine calls for “universal health care.” Which seems to this observer to be adding insult to injury.
“Some is good, more is better,” an old friend used to say. But, more medical intervention is often not better. It has been said repeatedly over the ages that the poor have some advantages over the rich. One advantage has been that they could not afford medical attention: thus preventing unnecessary procedures, avoiding useless or harmful medications, evading questionable surgeries, and missing dangerous hospitalizations.
“More is often not better.” But, more is usually more costly.
And, that is one of the major rubs of “universal health care.” Medical testing breeds more tests, one examination calls for another, one surgery often leads to another. And most readers will know that one pill usually attracts another — and another. Your doctor makes his income not by keeping you healthy but by bringing back to see him/her for appointments, tests and more pills.
All of this leads to “Going for Broke.” The already Broken Medical System is heading toward destruction. Expanding and increasing medical spending will not improve health. That can simply be evidenced, if not proven, because there is no such thing in the Western world as “health care.” We have an almost totally “universal disease care” system. “Health care” is almost unknown in the West.
So, unless we turn in a new direction, all our best intentions are merely “Going for Broke.”
The treasuries of many Western countries are empty, only holding off bankruptcy through trillions of borrowed dollars, pounds, and euros. Medical systems are no different. The United Kingdom recently had to add billions of pounds to bolster its National Health Service. The United States will surely follow suit to keep the supposed “Affordable” Care Act functioning.
Spending beyond one’s means is surely a common way to “Go Broke.”
Let us find Better Ways to create real health for everyone and to truly care for one another. There are many reasons to believe human beings can accomplish such a noble task.
Send comments to theportableschool at gmail dot com.
Hi, Interesting experiences.
Yes in todays world so many things have become and are treated as commodities and sadly that includes health “care”.
It is part of a system that is not sustainable, not only in the economic /financial aspects, but in many others as you clearly demonstrate in your article.
Things will have to change, there is no way around it. How they will change? Well that depends on human, group, society action, or collapse will bring the change any way.
This we know. The problem is, as often is, political will and critical thinking on the part of society.
Hey Dr. BOB ! Great essay ! Yes — — medicine practiced as business is oxymoronic. But that’s what is going on ! Most people are duped into some kind of magical thinking re the medical industrial complex ! Happy Thanksgiving ! …
Visit https://peoplemedicine.info for information about the author’s book: People Medicine: A Frugal Physician Prescribes Common Sense and Enthusiasm.