My blog represents my personal experiences and perspectives. This includes many anecdotes from my life and from my medical practice. I have been scrupulous to anonymize all medical anecdotes and to avoid ever belittling or making fun of patients. (I often make fun of and criticize myself, my colleagues, and the institutions where I have worked.)
I received a memo recently from an institution, extolling the virtues of its screening programs. It was entitled:
Screening Saves Lives.
It was in large block capitals. I call bullshit on this. Screening does not save lives. FULL. STOP.
It can be amusing when people mistake the map for the territory (sometimes called the reification fallacy). When it harms my patients, though, it pisses me off. And it isn’t just me, or my institution: two physician friends (in other states) tell me they are seeing it as well.
We couldn’t find her sneakers anywhere. They weren’t in the travel bag, under the bench in the mudroom, in either car, at friends’ houses, in the closet or under the bed. After two days, we gave up and bought a new pair sneakers.
A recent article in USA Today talked about Regina Holliday’s efforts to make the medical record more easily and promptly available to patients so it becomes as a tool patients use as they engage in co-managing their own care. Her cause is just and her story is compelling, so I was dismayed at the pushback saying: Not so fast.
"The art of progress is to preserve order amid change and to preserve change amid order. "
(Alfred North Whitehead)
What is True North for medicine? Is there an enduring core value that serves as a reliable touchstone across the nearly infinite range of medical activities? Given how medicine and society change, can there even be an enduring True North? If we have one, are we pursuing it faithfully?
I was asked by a colleague at work (someone who frequently but privately agreed with me but never spoke up publicly), “Why do you tilt at windmills?” Many have answered this better than I.
It’s always easier to do something than to do nothing. Doctors often offer treatments for things they know are what we call ‘self-limited’ meaning that they will clear up all by themselves. I think this form of unnecessary treatment reflects an awareness that although many things resolve without intervention, both doctors and patients are driven to DO SOMETHING. Though it is usually tempered by the wish to do something as benign as possible, sometimes doing nothing is the best choice. The trick is knowing how to do nothing properly.
We have LOTS of guidelines and recommendations. We we need is more humility.
The Advisory Committee for Immunization Practices (ACIP) issued a recommendation in September of 2014 that pneumococcal vaccine naive individuals 65 and over get a Prevnar13 followed by a Pneumovax 6-12 months later, and that those who have had a Pneumovax get a Prevnar13 a minimum of 12 months after their Pneumovax.
Under stress, including conditions of overload, systems degrade in a predictable manner.