Thursday, September 25, 2008

Pain of Uncertainty

Do you remember when, as a child, you first realized doctors can't fix everything? I do, but rather than recount the specific circumstance, I'm more interested in the "dance," as I came to understand it. Basically, MDs recommend tests, prescribe pills or refer to "specialists." Specialists recommend tests, prescribe pills or refer to surgeons. And surgeons cut, then prescribe pills. In the interstices, there are permutations on life-style changes that each will recommend; among the most famous: get some exercise, lose weight, and stop smoking.
I am not at odds with this structure. It works in many cases, as it did successfully with my, ahem, lower body surgery. But over the last say, 10 years, I have seen the ugly side of modern medicine.
Let's say you go to a doctor with a painful complaint or other symptom. You go through the dance, but pills don't help and surgery isn't indicated by any of the many tests you've taken. These tests tell you what you don't have. Now you enter a period of try this try that, and eventually you just give up and learn to cope. Second opinion? If insurance won't cover it, for any of several reasons, it's a non-option.
Another situation is pain management. I recently read a story about doctors who find themselves before the medical boards for prescribing "too much pain medication," and in several instances they are in trouble with civil authorities for "drug dealing." Many of these doctors were treating patients for chronic pain, like cancer or fibromyalgia. In fear of being persecuted, the article suggested many doctors will not prescribe sufficient pain meds but instead suggest pain management training or coping skills. Pain is pain, man.
Another situation is when a patient has multiple problems and is seeing 3 or more different specialists in addition to a PCM (primary care manager). No single one of these people is on top of the patients health situation in the holistic sense.
OK, my point is these three situations apply to my wife, who at the moderate age of 50, is basically an invalid. We are in limbo at this time waiting to see if a regimen of pills and therapy will restore her to some semblance of independence, but none of her doctors is making any promises.
The uncertainty of the future has a whole different meaning when it's about your health, than say, your favorite football team's next game.
As a kid, I remember my mom speaking in reverent tones about a doctor's visit (they used to make house calls in those days) like everything would be OK, because the doctor would see to it. The truth is a little disappointing--we mostly heal on our own for everyday ills, and doctors just prescribe symptom treatments. The truth is doctors can't fix everything, and in some instances can't fix anything. But, we dance.

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