Seven years have passed since I started this blog.
In that time…
I have learned some basics about writing. (I almost wrote, “I have learned to write,” which would have been foolish, since, writing-wise, I have plenty to learn.)
I have learned to stay upright on the bicycle. Concussions made me understand that the joys of criterium and cross racing don’t outweigh their risks. I still ride nearly every day; I’m a pretty fast bike commuter now. And I’ve shifted my endurance-sport goals to running, which is a far safer sport for the brain. My goal is to run 10k in less than 40 minutes.
The main thing that has changed about me is my views as a doctor, especially when it comes to dealing with people who complain of nothing.
Medicine is most pure when we treat people with illness. The infirmed come to us with a problem and we use our intelligence, experience and procedural skills to help them. It’s immensely gratifying. The joy of helping people still negates the stifling burden of administrative nonsense. I’ll do your damn corporate safety modules one more year because helping sick people get well feels so good.
But when people complain of nothing, our first job is to do no harm. I know prevention of disease is better than treating it, but the process of prevention gets dicey. When we prescribe things (screening tests, statins, aspirin, diabetes drugs etc) to people who complain of nothing, we should have the highest evidence these therapies deliver benefit. Too often, we cite eminence rather than evidence.
I’ve come to believe the medical profession is too paternalistic, too arrogant. I fear the medicalization of the human condition. These days, I order fewer tests. Medical tests put people into the “system,” on the metaphorical train of healthcare. This train accelerates quickly, and it’s often hard to get off. Even a simple echo scares me. I could tell you stories.
More often than not, I tell patients to stop checking their “numbers.” If they insist on health numbers, I favor three–the scale, the belt size and a Timex to measure walking speed.
A 2002 article from Dr. David Sackett (a pioneer of evidence-based medicine) perfectly captures my views on preventive medicine.
It’s called The Arrogance of Preventive Medicine. It’s worth a look, now more than ever.
Shortly after I tweeted the Sackett article, Harvard economist and professor Amitabh Chandra chimed in with this:
P.S. For a longer and more polemic view of preventive medicine, see also, Piotr Skrabanek’s… The Death of Humane Medicine. Be warned; you can’t unsee this stuff.