Cycling Wed Doctoring Healthy Living Uncategorized

CW: Buying bikes and health care

As a passionate cyclist, I really like it when someone asks for bike advice. Cycling is something I know a lot about–though probably not as much as Sal Khan.

Recently, a spin class enthusiast who was considering making the gigantic leap to outdoor cycling asked me whether it’s worth spending extra dollars on a super-light (“high-zoot”) bike.

While typing an enthusiastic e-response, a funny thing happened: I explained bike-buying by meshing it with getting (or giving) quality health care.

Here is how I answered the question about buying a bike. After each bike statement, I inserted the health care (HC) analogy.

Bike: Getting the right bike contributes significantly to the pleasure of riding.

HC: Getting the right health care contributes significantly to both quality and quantity of life.

Bike: You do not need the most expensive carbon bike–they are often uncomfortable, too twitchy and like expensive cars, depreciate immediately.

HC: You do not need the most expensive medical care. More than one study has shown that more care is not always better care. Specific examples of too much care include screening for low risk diseases, exposure to needless radiation and taking brand-name medicines when generics are sufficient.

Bike: On the other hand, I would not buy the least expensive bike. Clunky heavy bikes make it harder to enjoy riding. Crappy bikes provide less swoosh. Life is too short to roll lousy equipment.

HC: No right-minded person would argue that skimping on basic healthcare represents value. Pre-natal care, vaccinations, dental care, blood pressure checks and annual physical exams with a non-rushed doctor represent simple investments that are worthy of their nominal costs.

Bike: A medium priced bike that fits you well is a good starting point. Keep in mind, cycling outdoors requires far more equipment than just a bike. Like my fast new shoes:

HC: In medical care, “medium” is usually best. In AF ablation, a medium amount of ablation seems to work best. Too few burns do not isolate the areas causing the problem, and too much ablation creates areas that perpetuate new rhythm problems (medical people call this pro-arrhythmia). Take Cancer therapy as another example of balancing how much to do. Giving inadequate chemo, or doing smaller surgery runs the risk of leaving portions of the tumor to spread, while infusing too much toxic medicine, or cutting too much out with surgery enhances the risk of making the treatment worse than the disease. Medium. Balance, Thoughtful. Not too much, not too little, just the right amount.

Bike: The most important thing about buying a bike is finding a bike shop to build a relationship with. You will need them if you keep riding. Bikes will require both preventative and interventional therapy. One shop may be a tad more expensive than another, but if they offer superior service, the extra money is well worth spending. I don’t haggle bike shop guys. On the contrary, I try to be the least irritating possible; I frequently bring them coffee or pastries,  and I offer positive remarks when the bike is working well.

HC: The most important thing about getting the best medical care is building a relationship with a doctor–or, as Dr Kevin Pho emphasizes in his healthcare reform piece published in today’s USA Today, a healthcare team. You will want a team that is available, affable and able. Your body and mind will need both preventative and interventional care. If you find a good team, you should work with them. Basic things like being on time, treating office staff with kindness, knowing your medicines, having a list of focused relevant questions, and paying your bill will make it more likely to get and maintain good care.

Bike: I find bike shop people likable because they are passionate craftsmen who hang a lot of self-esteem on their results. Though they are frequently grumpy and crusty on the outside, most are warm-hearted on the inside. They might snark to you that the bike would work better if you took basic care of it. Cleaning the chain, pumping up the tires and bringing the bike in for routine maintenance are basic things they expect you to do. And bike mechanics will not respond kindly to demands for repairs immediately—as if you are more important than other customers.

HC: Your medical team is entirely human. They will get grumpy if you come in with a poorly maintained body and expect an immediate fix. Even though (US) doctors still get get paid per encounter (or procedure), we can sense futility. Few of us want to keep stenting blockages in smokers, or prescribing blood pressure drugs in patients who will not exercise, or ablating arrhythmias that could be controlled with better sleep, stress management and fewer gin-and-tonics. Most doctors want our patients to do well with the least amount of treatment. Really. If we did fewer procedures, there would be more time for writing blogs.

Who knew that buying a bike would share such similarity with getting health care?