What Are We Thinking?

As health care professionals we are charged with doing what is best for our patients at all times. There is no question that health care is now considered a right and that everyone expects perfect health forever. We, as providers, in an attempt to respond to the demands of our patients who have these expectations, order tests and tests and tests until we find something that perhaps can be “fixed” so that these expectations can be met.  Unfortunately, we fail to educate our patients about some basic considerations that involve health care. One of the most basic truths is that disease and aging cannot be avoided. Daily living is going to take a toll on the body. Another basic truth that must be faced is that not everything can be fixed even by modern medicine. I know some might find that hard to believe, but it’s true. I have had both knees and one hip replaced. The new parts are far better than my old, worn out ones, but they don’t allow me to run or play tennis as I did when I was 20 years old. The bottom line that we must accept is that we all are going to “wear out” and die at some point. Death cannot be avoided.  

Ordering tests just to appease patients and their search for perfect health is not without its problems. Invasive tests have inherent risks that can injure patients. Another issue with ordering unnecessary tests is the problem of false positive results. Every test has a built-in false positive rate that is higher for some tests than for others. Tests can be incorrectly done, scans and x-rays can be misread—many things can happen that give an unrealistic report of the patient’s health. A shocking example happened to a friend of ours when a misread CT scan resulted in his undergoing an unnecessary cardiac operation. What were they thinking?   

Many times, tests and procedures are done to patients without taking into account the patient’s situation. An acquaintance of ours is an elderly lady who keeps seeking medical attention for what she presumes to be skin cancers. The majority of these lesions are 2 mm to 5 mm in diameter. The physician continues to biopsy them (about 30% of which are truly malignant) and then excises them. Her wounds do not heal so we spend weeks and, on occasion, months trying to get the wounds to heal. Not one of those lesions is clinically relevant at this patient’s age. Instead of just reassuring the patient that these should not give her any trouble, he takes the easy way out and excises them. The expense and problems to this patient and her family are enormous. What are they thinking?

Another example of that happened with my father. He had a pacemaker placed at age 81 for a “slow heartbeat.” After he had the pacemaker for 7 years, the cardiologist called my mother saying that my father needed his pacemaker replaced. They checked the pacemaker and found the battery still had 70% of its original charge and was working perfectly. They still insisted he have it changed. At that time, my father had senile dementia and hardly did anything but move from the bed to a chair. What were they thinking? They finally convinced my mother to have it done over my objections. He did fine with the replacement but died 9 months later—but his pacemaker was working perfectly!  

We must stop this foolishness and practice medicine! We need to educate patients who have unrealistic expectations about their health, and, if necessary, refuse to be swayed to doing tests, procedures, and treatments that are not in the best interests of our patients. By continuing to search for problems to try to meet patient expectations, we are actually making patients less healthy. What are we thinking?