Sunday, October 10, 2010

Treating the Disease vs Treating the Patient

While I was pursuing my History of Science studies at Notre Dame I took a seminar course on Medicine and Society.  My last two posts are from that class.  I came to hate that class and it was a large factor in my decision to drop out of the program, but I did learn some important lessons during it.  The crux of the message that the professor was trying to get across to us was the way that the medical profession dehumanizes the patient and ends up treating the disease, and not the human being.  If you want to see this message in a very disturbing but highly distilled form just watch the film "Wit" with Emma Thompson.

This lesson was reinforced for me this past week when I had to rush home to Ohio because my father was in the hospital.  He went in for something relatively minor but ended up in the hospital for a week being treated for another condition.  A condition that was due, in part, at least, to actions taken by the hospital staff in their treatment of his original issue.  I am not saying that the staff was malicious in their treatment, but they were aggressive and interventionist, so that rather than assuming that the change in his condition might be due to the drugs they had given him they kept chasing symptoms. It quickly became apparent that the treatment was reactive - x happened, so they did y, without ever really trying to understand the whole picture, the patient. In the end my father spent a week in the hospital and underwent a procedure that was probably not really necessary.

It is hard challenging the medical profession when you are a patient, they are so authoritative, and when there is something wrong you get swept up into their treatment course and it takes over your life.  I saw this myself when I was undergoing treatment for breast cancer.  I tried hard to be an informed patient and question the treatment but there was one week in which I had a CAT scan, a PET scan and two biopsies.  Everything checked out as fine, but that week was quite an ordeal, both physically and emotionally.  My oncologist's conclusion after all of that was that if you did tests and scans you will always find something that is odd, and if you let yourself, you will chase these oddities for quite some time before concluding that while odd, they are not dangerous or unhealthy.  My oncologist now uses me as a poster child for not doing more than is necessary.  He still feels bad about putting me through that ordeal. 

There is a lot of debate going on right now about how to fix the health care system.  Well, one of the things they should do is treat the patient, not the disease.  One of the hardest things about being a doctor is the process of diagnosis (this is actually a place where expert systems could be useful) and rather than being thoughtful or logical about ordering tests they just order a whole suite of them.  It is as if they are throwing a whole bunch of darts at a dart board in the dark, hoping that one of them hits the target.  That is simply not a rational or cost effective approach to treatment.  It isn't good for society and it isn't good for the patient.

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