Email
PrintThe Virtues of Waiting and Your Health
When I was a kid and heard a song on the radio that I really liked, I’d work by cutting grass to earn some money and then go to the music store, order it, and finally would have the record. Today, kids hear a song, download it, and it’s theirs a few seconds later.
I was amused by my son, who’s an upperclassman orientating freshmen at the University of Michigan, when he complained about how impatient the freshman were. Just a few years have separated his modem dial-up experiences from the instant broadband generation of the younger students. He told me that if the freshman’s computer didn’t load immediately in less than two seconds, their hands were up in the air complaining that there was a problem. My son had to tell them to wait just another three seconds.
Three seconds! Just imagine if he had said 10 seconds! They’d be rolling in the aisles ready to explode and posting their dissatisfaction on some website.
So many people today lament that people have forgotten that you need to work for, and wait for, what you want.
What does this have to do with health care? A lot.
Many of the diseases, injuries and medical problems we see today follow natural biological process that, no matter what intervention we provide, would end up with the same results eventually. But our modern expectations of instant gratification are driving a lot of costs and treatments that may have dubious benefits.
For example, the vast majority of upper respiratory infections are viral and will run their course no matter what we do. Yet we get calls every day from patients wanting antibiotics “so they can get better faster,” not understanding that those only treat bacterial infections, a completely different organism.
Musculoskeletal injuries are another area where sprains and injuries like back pain usually gets better if we listen to our bodies and do the right things. But we often can’t wait – or we want to be fixed – so we get X-rays, MRIs, go in for treatments, shots and get surgeries.
Although, in some cases, certain medical symptoms do require urgent attention, there are many others that eventually will resolve if we are patient enough. Physicians constantly get calls every day from those who want to be seen immediately for anything – from a new bout of dizziness to a sore throat or painful foot, hip, leg or headache. Most of these symptoms just occurred and are new. The interesting thing is that in the busier practices, where the patients do eventually get in but not right away, by the time they make it into the doctor’s office, the symptoms are often gone or resolved.
Unfortunately, the medical culture gets caught up and pressured by those expectations to respond and produce results. Is “just do something” always the right thing?
Remember the whole thing about women’s hormones and menopause? How the new studies showed that they didn’t help with heart disease and increased the risk of cancer and blood clots? Even today, despite the American College of Gynecology agreeing with that, it’s been difficult for many providers to change what they’ve been doing for 30 years.
Another recent study said that one in eight U.S. patients who have non-emergency stenting procedures to clear blocked arteries in the heart are likely to see more harm than good from the procedure. The findings noted concern about overuse of the invasive treatment, which costs the nation some $12 billion a year and offers few benefits over drug therapy unless the patient has suffered a heart attack.
"More than half of the inappropriate cases were in patients who didn't have any symptoms at all," said Dr. Paul Chan, whose results appear in the Journal of the American Medical Association. Despite this study, there has been no shift by the average cardiologist, some of whom question the findings.
Recent studies on spine surgery have been fascinating. In one example, half the patients went through a “fake surgery” while in the other half it was real. Patients were not told who had what, but later on were assessed on how they felt. The people who did not have the surgery, but thought they did, fared just as well or better than the ones who had surgery.
Hence the phrase we’re all hearing more frequently: “Evidence-based medicine.” Medical therapies are now being scrutinized and studied in neutral environments (i.e. not funded by pharmaceutical companies), such as the NIH and academic centers. Much of it is questioning and challenging long-standing attitudes about treatments that doctors do.
Is it controversial? Heck yes, especially amongst practicing doctors.
A really interesting study going on right now is to show patients videos of their proposed surgeries and the post-operative and rehabilitative care using real patients and interviews. The majority of patients after viewing the videos had more questions and some changed their minds about the procedure. Critics say that this approach will make it harder to get patients to obtain the care that they need because they won’t just say “Okay.”
Perhaps.
But I believe that no matter how scary that video is, it should be our job as doctors to explain why an operation is worth going through, not the way other way around.
So what’s a patient to do?
Stay informed. Ask for proof and evidence of how the therapy or the test may improve your health. Decide on whether the costs and risks to you are justified by the evidence.
As we get into health care reform, access to primary care physicians is going to become far more difficult than it already is. We need to anticipate that and weigh our expectations. There is a value to waiting. Sounds good, right?
Now, if we tell you to wait a week, possibly two, and your cold or your sprain will be better, but there’s nothing else we could be doing to “speed it up,” will you be happy?
(I’ll bet some of you said, “That @&%# doctor just told me to suck it up!)
Sure is hard in this “three second generation” to wait, isn’t it?
