17 April 2011

An Ounce of Prevention

I spent all winter doggedly NOT ordering flu tests. According to the algorithm provided by Children's, low risk individuals (whether they have the flu or not), are not eligible for treatment. So where's the use in testing? Why should I spend the healthcare system's money if my recommendations for 'supportive care measures' - ie. tylenol and motrin - is going to be just the same as for any other virus?

This is easy enough to do at Children's, where everyone else is doing exactly the same thing. But at the community hospital where I also work, I occasionally pick up the child in a mother/father and child combo. The parent is also there to be seen for flu-like symptoms and the doctor who sees mom or dad orders a flu swab and it is positive. Sometimes that doctor even initiates treatment with Tamiflu for the parent and I am left looking like...what exactly? Like I don't care? Like I don't believe the child is worth the cost of the flu test or a prescription for Tamiflu?

No. Because more medicine is not always better medicine. Sometimes the right thing to do is nothing at all. Would you want to take a medicine you have more chance of having a bad reaction to than finding relief from? Probably not. Having a flu swab shoved up your nose, or your toddler's nose, is exceedingly unpleasant. Why put him or her through that if it doesn't actually help? Especially if you chose not to vaccinate (which would actually have helped) because, as one mom of a six-year-old put it, "she doesn't like needles". No kidding. Who does?

Friday's Washington Post had an opinion piece written by one of my favorite teachers from my residency years, Dr. Sean Palfrey. Read it here. I'll hazard a guess based on what Sean wrote about preventive care and limiting unnecessary testing in order to improve our healthcare system as a whole that he would be more in favor of flu shots than flu swabs, that he would rather see his patients protected against illness than diagnosed with it. When you put it that simply, who would argue?

That sounds like a rhetorical question, but it's not. I actually want to know. Who would argue? Who are you faceless commentators who use the anonymity of the internet to unleash the most vitriolic and caustic statements, no part of which are grounded in fact? I am not referring to those who engage in the discussion to further it, who find fault with the assumptions or wording in a given piece in order to encourage the readers to consider points the author may not have considered or had space for. 

The thing about writing a piece that goes to publication is that you cannot take it back. For better or worse, it is out there. All the nuance and the flip flopping that normal, intelligent people do in the process of grappling with truly tough issues, is reduced to a seven-hundred word essay. You do the best with the space you have. You welcome the dissenters because the point of writing (contrary to the Fox News ethos) is not to ram your bombastic opinions down the throats of others but to offer them up for consideration and debate. We are all the richer for such intercourse.

When cunn9305 remarked on Sean's article, it was not entirely laudatory: "Hey dude ... speak for yourself ... I am a surgeon..." I would venture to say that the "hey dude" already clued us in that he was a surgeon (and yes, I'll take a wild guess and say cunn9305 is a he), but aside from being redundant he raises the very valid point that the consumer/patient in medicine expects perfection and so not ordering available diagnostic testing puts the clinician in a vulnerable position in terms of possible malpractice. Granted. If the issue of to test/not to test were simple, then I doubt the Post would have bothered to publish the piece.

But then you come to the rantings of rscott1293. At the risk of giving more credence to a nut job than he or she deserves, I'll go ahead and cut and paste as is:

"God help the students you are teaching on a daily basis. Your concept of reasonable care and reasonable outcome simply is rationing of care. Preventative and thoughful medicine to an idealogue such as yourself means looking and listening without placing a stethescope on a kid, without doing bloodwork, no x-rays, scans , etc...... You are the physician that hospitals and other professionals speak of when commenting on the downfall of medicine in America. You are putting medicine in the bucket of minimalism. You are a bean counting bureaucrat, a pimple on the face of healthcare in America, a useful idiot of the leftist, socialist, one-size-fit"s all scum that resides on the shady side of medicine today. In all likelyhood you finished close to dead last in your class and totally failed at providing good bedside care and barely passed your clinicals. You should be relegated to providing 8 to 5 care in a primary care clinic a a mall hidden deep in America."

Now I've been encouraged in the past to accept that by putting yourself in the public eye, in however limited a manner, one must expect some degree of irrational dissent. Perhaps it is best, as my husband has suggested, to not even read the comments on any internet article as it only leads to a loss of faith in humanity.


But aren't there also times when you just want to be able to ask, why? Why should someone choose to be so hurtful, choose not to engage in the issues but instead to fling metaphorical feces at an individual who just happens to be one of the finest doctors I know? Even were Dr. Palfrey not the epitome of a compassionate primary care pediatrician, even if he were just an average or adequate sort of doctor, that still does not excuse such a hateful collection of words, words that serve only to tear down and not to move forward the discussion of what to do with a healthcare system that is so obviously broken.

Starting tomorrow I'll try to take my husband's advice and skip the comments section. For today, however, let me take just a moment to say:  

Shame on you, rscott1293. From now on you should read your comments aloud on a street corner before you post them. Then, when strangers actually feel compelled to stop what they are doing to wash your mouth out with soap, take that as a sign that you have stepped unforgivably over the line.

1 comment:

  1. Well stated, Meghan...rscott opines in a direct, yet hyperbolic and ultimately self-destructive fashion like so many of his ilk. Medicine will become what each person allows it to become, regardless of geography: a brief visit to a nameless mall for a quick MD physical 12 years ago turned into the best doctor-patient relationship I've ever had...thorough, watchful, caring, and a brilliant diagnostician.
    The future of medicine in the US has already been presented to us in a shorthand fashion by the healthcare debate and each person will be even more responsible for the right fit of care for his family, not just the physician.