Last night I talked with one of my partners about a few terrible cases of medical harm from unnecessary procedures.
He said, “John, people get this stuff done to them because they fear not being healthy. People are scared.”
My answer was that people should fear healthcare more than they do disease. That sounds like hyperbole, but it is not.
When you are sick, medicine is beautiful. It’s never been better.
But when you are well, you should fear getting stuck on the healthcare train. It moves fast. It’s hard to get off.
I’ve never been more frightened to order a test. Any test, even an echo, can get you on the runaway train.
It’s weird; the more techie we get in medicine, the more I focus on the history, exam and ECG.
My partner again: “John, when we treat people who are already well, all that can happen is we make them worse.”
He means two-times well is still well.
You may wonder how you know that you are well?
You don’t need an app or a biomarker. Don’t listen to the hype. All you need is a scale, a belt, and a Timex to time how fast you move from point A to B.
One of my favorite studies published this year showed that the best predictor of 5-year survival was self-reported health and walking speed.
Health is not complicated: If you move quickly and you grade your own health as good, your prediction is probably better than any doctor’s.
Don’t misunderstand this as a screed against prevention of disease. I’m for prevention. But you don’t need medical care for prevention. Besides luck, avoiding diseases like heart disease and cancer turns not on tests, drugs, and procedures, but on basic lifestyle choices. It’s why we need parks, bike lanes and walkable neighborhoods more than we need cath labs.
When we change the culture of what we fear, we get closer to stopping overdiagnosis and overtreatment. We get closer to RightCare.