Wednesday, November 12, 2008

Overtreated

When I lived on Orcas Island, one of the most profound things I've ever heard in my life was said to me in a conversation at Sauna night one Sunday shortly before I left in October. Tim the Human is called so to distinguish him from his friend Tim F. and because he did research living with gorillas for years and needed to be distinguished from them. He does a phenomenal gorilla impression. I asked Tim the Human where he had been all summer.

He said very simply, "I joined the tribe of a friend of who dying for about a month."

It would be easy to disregard this as hippy-talk but I was really moved. This was community, the thing that I went to Orcas to find. No one lived in denial that this man was dying. Instead, a dozen people moved nearby so that he would be surrounded with friends when he did. This means that a dozen people looked at the routines of their lives and decided that making money wasn't as important as loving their friend.

What if our society allowed us to be that kind of person all the time?

I'm reading Overtreated by Shannon Brownlee for my one of my classes. It describes the economic incentives in American society that encourage people to believe they are sicker than they are because it helps other people make money and is good for the economy.

It's heartbreaking. Good research shows that American spends more on health care per capita and actually have shorter life expectancies than any other developed nation.

And because of systemic financial incentives, we live worried about our health rather than surrounded by love. If Tim the Human's friend had bought into this mentality, he would have been in hospital undergoing invasive tests that were unnecessary because he couldn't have been treated for what they found anyway because he was too weak. Instead, he accepted that the payment for a life of love is death. Interestingly, the payment for a life of worry is also death.

When I was 20, I had a sore throat all the time. I went to my mom's doctor and first he looked at me and said, "Really? Every day?" in a tone of such incredulity and paternalism, I might have crumbled right there and admitted no, maybe not every day just to make him stop looking at me that way. But I was teaching and I was eating 6 or 7 cough drops a day to get through all of my classes so I knew the answer was "yes, every day." Luckily, I had recently taken a health class that changed my life by pointing out how many doctors set up a parent-child dynamic because it makes life easier for them rather than because it makes patients healthier. With this new-found knowledge, I insisted that it hurt every day. He asked a few cursory questions about my allergies and the daily medicine I was taking for it and said finally that maybe I had acid-reflux, a new disease in 1995, ordered a series of blood tests and warned me that he would probably have to prescribe a pill I recognized from commercials.

I didn't like the off-handed way I had been treated and looked for a second opinion with an ear, nose and throat doctor who said I should have my tonsils out, especially since my father had also had his out in his early 20s. My younger brother pointed out that this same doctor would be the one who would do the surgery, which would get him more reimbursement from my insurance, so of course he thought I should have my tonsils out.

By this time, I had new insurance and looked for a doctor of my own. On this newfangled internet, I searched their database and found a 55-year-old woman who had gotten her medical degree in the last few years. A perfect candidate for someone who would actually listen to me. It turns out she had been the office manager for her husband's practice and went to med school as her children got older and moved out. She was short, had wild curly grey hair and reminded me a little bit of a hobbit. She asked what I was reading when she walked in to the exam room and had opinions about the book. She asked me lots of questions about my throat and determined that the allergy medicine - which was a blend of antihistimine and decongestant, also new-fangled in 1995 - was drying me out too much. She changed my prescription to an older version of the drug without decongestant that was no longer being advertised on TV and prescribed a separate, milder decongestant.

My sore throat went away.

It wasn't acid reflux.

It wasn't bad tonsils.

I wasn't sick at all.

I was taking the wrong medicine.

This was not my only experience like this in my early twenties when doctors wanted to make me sicker than I was and to prescribe more medicine to fix what turned out to be side-effects of other medicine. In my last semester at school, I was crying every day but able to get out of bed and get all of my work done every day. Conflicting symptoms for depression. I had to see 2 mental health specialists who wanted to prescribe prescription anti-depressants until I found a third who suggested I change birth control methods before I did anything drastic.

I am grateful for those early experience and for that health class. I worry much less that I might be sick and assume much more that something is simply out of balance if I'm not feeling well.

My sister-in-law's mother died in bed at home surrounded by her family and friends, most of whom grew up with her in India. Like Tim the Human's friend, throwing off the denial that death is inevitable let her find balance since the weight of fear was gone and her friends were there to hold her up. She could not fall; she could only move forward like the tightrope walker that we all are.

What if we lived that way all the time? Expressing gratitude for the health we have, seeking help only when something is debilitating or when prevention will make life better? I know it's more complicated than that for a lot of people but for a lot more of us, we look for problems with microscopic focus so that we don't have to look up and see with our own eyes. If we look down, we do not have to move forward. If we don't move forward, we're less likely to fall. But what if we recognize that for the lie that it is? The most dangerous point for a tightrope walker is when she loses momentum. If we focus on creating community, won't the love that results keep us balanced? With that, we cannot not fall but get to keep moving forward, closer to God's kingdom with the light from there illuminating the things around us more and more, showing them to be more beautiful than we ever thought they could be.

2 comments:

Anonymous said...

Like the bloodlettings of the middle ages (and up through colonial times), doctors have struggled with a limited body of knowledge. However, that doesn't account for the closemindedness that I've seen from most physicians. For many, it's almost as though they figured that their "comprehensive" medical training ended when they received their MD and if they hadn't learned it by the time they graduated, it wasn't worth knowing. Drugs are the hammer that many physicians wield and we, the nail that they see. I've frequently had to say no to drugs (thanks, Nancy) simply because my physicians were overzealous at solving problems that didn't need correction or were better addressed with lifestyle changes.

However, healthcare has gone through a few shifts in the last several centuries. From a model of the four humours to germ theory to psychoanalysis and now to homeopathic and preventive care, the entire system is beginning to evolve. The educational wing of the medical sector seems to have been a bit slower in keeping pace, but I think we're bound to continue evolving in how we perceive healthcare.

Christy said...

I'm totally sending this to a friend who's a Dr. And my mom, who's a nurse.