Thinking Out of the Box

Wouldn't it be great if every patient presented according to a textbook? It would be easy to recognize a set of symptoms, and choosing a treatment plan would be obvious. Unfortunately , there are so many variables from patient to patient that such simplified medicine is not always possible. Yet doctors have to start somewhere, so they rely on the medical expertise of others, the textbooks and the guidelines, to guide them. Quoting James Lock, chief of cardiology at Boston Children’s Hospital, James Groopman wrote in How Doctors Think:

“The big problem is that most people assume that once [a medical treatment protocol is] made up, it’s actually real. Especially the people who make it up themselves. Then they think it came straight from God…. Not everyone in medicine can be constantly making calculations about the value of the information. You’d go crazy. But if you are in a subspecialty field, as you train, you not only need to know what people know, but how they know it. You have to regularly question everything and everyone.” p. 135

If medicine worked like a cookbook, there would be little need for doctors. We could look up our symptoms ourselves and know the diagnosis and the treatment. (In this age of managed care and short doctor appointments, perhaps that explains why there is a proliferation of diagnostic sites for patients on the Internet.) But we are hoping that the extra training that goes into making physicians will enable them to begin with the textbook, but expand to include the patient.

Groopman, J. (2007). How Doctors Think. New York: Houghton Mifflin Company.

Walmart medicine

From MedPage Today, a doctor-reviewed medical news source, comes information that patients are going to "retail medical clinics," such as those operated by Walmart, for their common complaints, more often than they would go to a primary care physician.

http://www.medpagetoday.com/PublicHealthPolicy/HealthPolicy/tb/10882

Their study, reported in the September/October issue of Health Affairs, also disclosed that 61.3% of retail clinic patients (SE 0.04%) had no regular primary care physician....those 18 to 44 years old, were a disproportionate share of retail clinic patients.

Young adults, most likely not to have health insurance, are going to walk-in clinics for basic care, and if those clinics were not available, they wouldn't go to anyone. Apparently, Lyme patients are not the only population underserved by the medical community.

Enthralled by Research

There is always a concern that medical research not be indulged in merely to learn knew things, but that it should first concentrate on things that are of help to the patient. From the book, Hospital: An Oral History of Cook County Hospital comes this quote:

Then there's how medical science works. We had another site visit, and at one point this mean-spirited site inspector said, "You all have to understand, NCI [National Cancer Institute] funds research to stop cancer, it doesn't provide patient care." And another doctor, Richard Cooper, said, "Maybe that's why the rate of cancer has gone up."

Overly simplified? Yes. But worth remembering.

Lewis, S (1994). Hospital: An Oral History of Cook County Hospital. NY: The New Press.