…and this is the crux of the practice of medicine.
I just had a Eureka moment while talking on the phone with a patient. We were discussing how to manage her increasingly frequent episodes of atrial fibrillation. She was also dealing with two other major health problems.
She asked me:
Are these things connected?
In other words, was the increase in episodes related to her other problems?
This is what I’ve been trying to tell anyone who will listen.
In the human body, it’s all connected.
Some might say I spend my days treating heart rhythm disorders. That’s not accurate. I am treating people who have heart rhythm disorders. That person I am seeing may have kidney problems, cancer, arthritis, depression, sleep disorder, a recent surgery or any host of other issues. What’s more, that person has his or her own goals for care.
My job, therefore, isn’t just to suppress the rhythm problem. That’s an easy task. Rather, my job is to make the entire person better. That may mean not treating the rhythm. It may mean educating, empathizing, or helping the person manage other more pressing problems. It surely means seeing the effects our treatments will have on other aspects of human life.
Whenever we treat a disease, any disease, it’s vital that we see the person we are treating.
I repeatedly teach patients that my task is to help them without making them worse. AF is an easy example. The disease gets most scary when doctors get involved. We need to see that fact. We need to teach our patients that fact. There is no free treatment–it all comes with tradeoffs. Anticoagulants reduce stroke risk but increase bleeding risk. AF ablation reduces symptom burden but the procedure comes with a risk for serious complications. Statin drugs reduce the risk of a future heart attack but increase the risk for diabetes. You see the trend.
Cancer is another example. Why is the mammogram story so important? It’s because chemotherapy, surgery and radiation are so hard on the person. When I was in medical school the challenge of treating cancer was to kill just the cancer cells, not the normal cells. That remains the challenge. Surviving cancer often means surviving the treatments doctors prescribe. And that requires an entire person.
Treating disease in the elderly is perhaps the most important time to see the person rather than her diseases.
This precarious balance of connectedness is what makes doctoring so damn special.