Emergency departments are distilleries boiling complex blends of trauma, stress and emotion down to the essence of immediacy: what needs to be done, right now, to fix the problem. Working the past twenty years in such environments has shown me with great clarity what is wrong (and right) with our nation’s medical system. It’s obvious to me that despite all the furor and rancor, what is being debated in Washington currently is not healthcare reform. It’s only healthcare insurance reform. It addresses the undeniably important issues of who is going to pay and how, but completely misses the point of why.
Healthcare costs too much in our country because we deliver too much healthcare. We deliver too much because we demand too much. And we demand it for all the wrong reasons. We’re turning into a nation of anxious wimps.
I still love my job; very few things are as emotionally rewarding as relieving true pain and suffering, sharing compassionate care and actually saving lives. Illness and injury will always require the best efforts our medical system can provide. But emergency departments nationwide are being overwhelmed by the non-emergent, and doctors in general are asked to treat what doesn’t need treatment.
In a single night I had patients come in for the following complaints (all brought by ambulance): “Smoked marijuana and got dizzy”, “stung by a bee and it hurts”, “got drunk and have a hangover”, “sat out in the sun and got sunburn”, “ate Mexican food and threw up”, “picked my nose and it bled, but now it stopped”, “just had sex and want to know if I’m pregnant.”
Since all my colleagues and I have worked our shifts while suffering from worse symptoms than these (well, hopefully not the marijuana), we have understandably lost some of our natural empathy for such patients. When working with a cold, flu or headache, I often feel I am like one of those cute little animal signs in amusement parks that say “you must be taller than me to ride this ride” only my sign would read “you must be sicker than me to come to our emergency department.” You’d be surprised how many patients wouldn’t qualify.
At a time when we have an unprecedented obsession with health – Dr. Oz, The Doctors, Oprah and a host of daytime talk shows make the smallest issues seem like apocalyptic pandemics – we have substandard national wellness. This is largely because the media focuses on the exotic and the sensational and ignores the mundane. Our society has warped our perception of true risk. We are taught to fear vaccinations, mold, shark attacks, airplanes and breast implants when we really should worry about smoking, drug abuse, obesity, cars and basic hygiene. If you go by pharmaceutical advertisement budgets, our most critical health needs are to have sex and fall asleep.
Somehow we have developed an expectation that our health should always be perfect, and if it isn’t, there should be a pill to fix it. With every ache and sniffle we run to the doctor, or purchase useless quackery such as Airborne or homeopathic cures (to the tune of tens of billions of dollars). We demand unnecessary diagnostic testing, antibiotics for our viruses, narcotics for bruises and sprains. And due to time constraints on physicians, fear of lawsuits and the pressure to keep patients satisfied, we usually get them.
Yet the great secret of medicine is that almost everything we see will get better (or worse) no matter how we treat it. Usually better. The human body is exquisitely talented at healing. If bodies didn’t heal by themselves, we’d be up the creek. Even in an Intensive Care Unit, with our most advanced techniques applied, all we’re really doing is optimizing the conditions under which natural healing can occur. We give oxygen and fluids in the right proportions, raise or lower the blood pressure as needed and allow the natural healing mechanisms time to do their work. It’s as if you could put your car in the service garage, make sure you gave it plenty of gas, oil and brake fluid, and then expect the transmission to fix itself.
The bottom line is that most conditions are self-limited. This doesn’t mesh well with our immediate-gratification, instant-action society. But usually that bronchitis or back ache or poison ivy or stomach flu just needs time to get better. Take two aspirin and call me in the morning wasn’t your doctor being lazy in the middle of the night; it was sound medical practice. As a wise pediatrician colleague of mine once told me, “Our best medicines are Tincture of Time and Elixir of Neglect.” Taking drugs for things that go away on their own is rarely helpful and often harmful.
We’ve become a nation of hypochondriacs. Every sneeze is swine flu, every headache a tumor. And at great expense, we deliver fantastically prompt, thorough and largely unnecessary care. There is tremendous financial pressure on physicians to keep patients happy. But unlike business, in medicine the customer isn’t always right. Sometimes a doctor needs to show tough love and deny patients the quick fix. A good physician needs to have the guts to stand up to people and tell them that their baby gets ear infections because they smoke cigarettes. That it’s time to admit they are alcoholics. That they need to suck it up and deal with discomfort because narcotics will just make everything worse. That what’s really wrong with them is that they are just too damned fat. Unfortunately, this type of advice rarely leads to high patient satisfaction scores.
Modern medicine is a blessing which improves all our lives. But until we start educating the general populace about what really affects their health and what a doctor is capable (and more importantly, incapable) of fixing, we will continue to waste a large portion of our healthcare dollar on treatments which just don’t make any difference.
Dr. Thomas A. Doyle is an emergency physician who practices in Sewickley, PA. He is the author of the forthcoming book “Suck It Up, America: The Tough Choices Needed for Real Health-Care Reform”