A Question for Doctors: Are Sick Patients More Important Than Healthy Patients Who Are Trying to Stay Healthy?

Continuing... 

Now that I am in my late 60s I often worry that I am losing it. Incidents involving misplaced keys or forgotten grocery items take on an enhanced importance. But when I tell myself to step back from the panicky emotion and look at the present situation in a larger context, I can recall that I used to make the same mistakes in my 20s and 30s. It’s not so much actually losing it but anxiety about losing it that is at work here.

For doctors and medical administrators, anxiety about what might happen can cause temporary blindness to what is actually happening. In my conversation with the Medicare doctor it was clear that he was extremely concerned about harm that might come to women when estrogens were prescribed inappropriately by their doctors. For example, the WHI 2002 study did show that older women with existing heart disease should not be initiating hormone replacement therapy. In order to protect those who should not be taking estrogens, Medicare has erected a series of hurdles that must be negotiated each year by all patients wanting to take these medications (and their nurses and doctors). This situation means that many women who could avoid menopause symptoms (and possibly be helped by beneficial side effects) are excluded from taking a drug that could improve their quality of life and might actually extend their lives (depending on what current and future research shows).

The same reasoning seems to be at work in our current version of preventive medicine, which applies treatments and test to millions of healthy people so that a few can avoid illness. Jeff Wheelwright discusses this situation in an article entitled, “Risky medicine: Misunderstanding risk factors has led to massive overtreatment of diseases people don’t have and probably never will.” If 100 people are treated with statins for 10 years only 4 will be saved from having a heart attack. For every 1000 women regularly screened with mammograms over the age of 50 one life is saved. Often overlooked is the fact that these interventions harm a certain number of healthy people.

The medical community needs to take a step back and ask itself questions like these:

- Is it more important to protect the sick or to maintain the healthy?

- How many healthy people are we willing to put at risk in order to spare one person
     from disease or death?

- How many healthy people are actually being harmed by any given intervention?

- To what extent can we accommodate the needs of both groups?

- How much is all of this costing?

Doctors dedicate their lives to helping patients. From med school onward they learn to interact and empathize with those who are suffering from illness. In the larger world, however, most of us, most of the time, are healthy. If that were not the case, no health care system could ever take care of all of us. When medical policy decisions are made,­ healthy people who are trying to stay healthy need to become part of the calculation.