Resist the Hype
Section titled “Resist the Hype”A patient comes to see me about a painful knee. As I palpate it and test for restrictions in movement, he looks at me hopefully and asks, "Shouldn't I get an MRI?" or maybe he says "My wife says I should get an MRI." I understand what this is about. Like all of us Americans, my patient lives in a culture that reveres high-technology. If he puts his knee in a big, powerful machine with screens and computer read-outs, he feels like he is getting the most advanced healthcare possible.
I sympathize with this feeling, but the truth is, the MRI does not have the power to heal. With careful questioning and examination, a competent doctor can get a good idea of what is likely to be wrong with a painful knee. Most often, a therapeutic trial of anti-inflammatory drugs or herbs, with or without physical therapy, will return the knee to normal. The one time out of ten that the knee does not get better, I refer my patient to an orthopedist. If the specialist thinks an MRI will help, he can be sure your $1000 goes towards buying the proper kind of MRI (Contrast or not? The one millimeter resolution machine or one that provides even more accurate images?) The MRI itself will do nothing to heal the knee. Bells, whistles, LCD displays and all, the only value of the test occurs when that skilled orthopedist looks at the test to help decide what treatment will help you most.
I believe the yearning for high-tech solutions both interferes with good medical care and contributes to the medical cost crisis. We are a consumer culture, and we tend to think that healthcare - like computers or cell phones or beauty products or dish soap - is another commodity. We're trained to look for the best product or the best deal available and we are attracted to what is new and technically advanced. We see power and brilliance in the product and, unconsciously perhaps, we imagine that in buying the product we will absorb some of that power. University of Washington professor Richard Deyo, MD, details this in "Hope or Hype: The Obsession with Medical Advances and the High Cost of False Promises". He gives many examples of doctors and patients beseiged on all sides with commercial interests pushing the latest technological marvel. We buy those marvels at our own risk, not just of our pocketbook, but of our health.
Good healthcare is not a commodity - it is a working relationship. The process of medical care requires work by both physician and patient. When you see that Olympic medal awarded, you know both the coach and the athlete have contributed their best effort. They didn't look outside themselves to some shining product but focused on developing effective strategies and working together to carry them out. Your medical relationship is like that. The power lies not in a high-tech test, but in you to do the prescribed activity, to adhere to nutritional changes, to take medications or supplements. The power lies in the doctor in arriving at the most accurate understanding. The power lies in your communicating and working together. The power lies in using technology appropriately.
Don't let your doctor or other caregiver "hype" you either. If you find yourself in a medical relationship where you cannot communicate and the doctor seems to keep all the power, then maybe you should consult another physician.
Recently I completed the book "Second Opinions" by Jerome Groopman MD. Groopman tells about a severe backache he suffered as a young man and his hasty agreement to back surgery in hopes of a cure. The cure never happened, and his back has hurt ever since. With bitter experience, he's learned that he should have gotten a second opinion rather than jumping on the first measure offered.
Dr Groopman tells the stories of several people with perplexing or difficult medical problems, and how they obtained second (and third or fourth) opinions to help return to health. In each case, the person did not take the white coat on the doctor as evidence of competence. In each case, the person took power into their own hands to coordinate their own medical care. In each case, the person benefited.
There are plenty of forces in our culture offering us mysterious power that comes from outside ourselves - the authority of the white coat, cure-all supplements, high-tech machines and tests. Remember, the greatest power for health lies in your body's physiologic ability to heal both physically and emotionally. That power lies in your own healthy choices and in a good working relationship with your health care provider. Don't give up your power. Resist the hype.
Summertime, Scrapes, and Scratches
Section titled “Summertime, Scrapes, and Scratches”Summertime is the time for scrapes and scratches. When you are stocking that vacation medical kit, choose bacitracin as your topical antibiotic, not Neosporin. Neosporin contains neomycin which can cause pain after application and, in some people, causes a rash. Plain old bacitracin is much less likely to cause a rash and, being generic, is less costly.
Pfizer, the maker of Neosporin, has newer versions including Polysporin that do not contain neomycin. See details at http://en.wikipedia.org/wiki/Neosporin.
In my view, a healthy child or adult with a minor skin infection obtains maximum benefit per buck with bacitracin alone, always remembering the good old hot soak (see the August 2005 newsletter).