Saturday, February 9, 2008

what if...?

OK, I've dealt with tmi (too much information) as a subject before, but I have to return. Now it's the "what if" factor. Parents can find out so many things on the internet. They get way more information than they are ready to digest, but they don't often know that. They have no filters.
So, "what if" is a common question. One I didn't used to get 15-20 years ago, and one I bet my dad never got. What if it's pneumonia? What if it's cancer? Leukemia? Broken? Rotator cuff? Autism? So many my head swims some days. Not that the questions are always unwarranted, but they sort of take me off my "groove". I have a sort of script in my head sometimes for a visit and how I'd like it to go and when I'd like to share information about "ruling out" certain things. It really has more to do with me than with the patient, so I guess I shouldn't be so conscious of the rhythm or the tone of the visit if I answer the questions and help solve the problems to the best of my ability and to the patient's satisfaction. But the "what if's" are sort of scary in a way. What if I don't have an answer? What if it is meningitis and I didn't consider that? It is entirely possible that I haven't considered every single possibility. 
When I get a "what if" it's a challenge to me and my professional demeanor and expertise, whether the patient knows it or not. Maybe I have considered this or that diagnosis, but haven't mentioned it because it is so unlikely or I'm waiting to go down my list of "what I think it is" before I get to that one and the reasons I don't think it's that. Maybe I don't even want to mention my own complete list of things I'm "ruling out" (see blog of similar name previously) to try not to scare the parents or make them think of something more ominous than they are currently thinking. Aside: we get this in screening tests in newborns fairly often. A positive screen for cystic fibrosis with a nice comment on the bottom of the sheet from the health department that though this screen was positive, it's probably nothing. Then why did you report it to me? And what am I supposed to do about it? Like the heart murmurs so often heard in newborns; if I tell the parents about it, the kid's got it forever! "What if" it's his heart? Remember he had a murmur!? How much information should one share? I'm trying not to be a facilitator of the info overload, but in this day of webmd and google, it's not like parents are blissfully ignorant unless they really want to be, and even then, they have some friend or relative who surfs the web and shares her findings with them, often using a bludgeon rather than a pillow to posit her own theories on what's wrong based on her exhaustive, though completely uneducated, research. Sorry for the sidebar. And, sexist that I must be, I did say the friend or relative who researched everything and shared it with no thought of the effect was a "she" and I did that partly by eenie meenie minie moe and partly by design, since it seems that, from well-meaning aunts and grandmothers to the lady you've never seen before in walmart, it's rarely, rarely, a man who does this. Why? I don't know. Maybe guys don't care enough to search the very best. Have you ever heard of a grandfather causing a ruckus in a family due to his opinions if he was not suffering from dementia in some form? 'Nuff said. Oh, one more. If a dad who isn't the primary caretaker of the child brings a boy, infant or otherwise, to see me, I can bet the problem is about the penis. That's pretty much what we care about! This observation has held true for many years. 
More people want more tests these days to cover for the "what ifs" and there are vultures out there willing to suck you dry to allegedly make you feel better because now you know it is or isn't a torn ACL or a brain tumor or it's just that he isn't talking yet and it's not autism. Sure, I could do lots of tests on lots of patients, and I'd probably get some information I didn't have before the test, but in my experience, most tests lead to more tests rather than more answers. If all a doctor did was order tests, which it seems is occurring  more and more, then why do you need the doctor? You could go to Google, type in your list of symptoms, get the tests to figure out which thing it is, then order your treatment from the online pharmacy without a prescription. I'd best not give Hillary any ideas, so I'll quit this line of thinking, but suffice it to say, we physicians have allowed ourselves to be test-orderers and pill-prescribers instead of diagnosticians and allies in health, and it's our loss and yours.
So, what if things were different? If insurance companies weren't our biggest source of income and we listened to and treated patients the way we wanted and they needed instead of the way the insurance companies and pharmaceutical companies say we should? If you didn't know about ED and Viagra unless you went to the doctor and told him your problem? If you hadn't heard of ADD and if it didn't seem to be such a convenient explanation for Billy's problems at school and what was the name of that new medicine on the back cover of Newsweek? 
What if? What if we ate better and lived better, rather than longer, lives? What if we rested on the Sabbath rather than cram all our activity outside of work into that day? What if we just did nothing sometimes and didn't feel guilty? What if we let our batteries recharge and paid less attention to the crazies on Oprah and at walmart and if we trusted our Creator to know what's going on and to have a plan for us and that we don't always have to know all the answers though science/medicine is doing its best to convince us they (we?) know everything but they/we change it every once in a while to keep you guessing and to keep our profit margin healthy with a new drug or treatment? What if?
Sorry, I know it rambled, but hey... 

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