Musings of a Dinosaur

A Family Doctor in solo private practice; I may be going the way of the dinosaur, but I'm not dead yet.

Monday, July 13, 2009

Living Well

Sing it, sister:
Somewhere along the way in our News You Can Use culture, good health has taken on the patina of virtue. Like good grades and job promotion, health is seen as bestowed upon those who work for it. There's no excuse for not doing everything you can...
As I have intimated previously:
The flip side of this is the judgment passed on those who get sick. They must have done something wrong, their diet must be flawed or they are overweight or drink too much or don't drink enough. Weight is the easiest handle for bestowing blame because we can see it and because we have been taught to associate all manner of poor habits with excess weight.
News flash: life is for living. Although I and others have found our life's calling to be in health care, that doesn't mean that everyone else has to spend every waking minute thinking about what I, as their doctor, might have to say about how they live their lives. So why do they?:
We take our medicine with a side order of morality because it is within the doctor's office and the hospital that scores are tallied and winners are distinguished from losers. Scores must be tallied somewhere, otherwise there would be no reward for all the hard work of keeping healthy, no prize for all the self-denial of doing everything right. We did not pass up all those rich desserts for nothing.

Read the whole thing.

(h/t Jockette)


At Mon Jul 13, 11:42:00 AM, Blogger Patrick Baroco said...

Life should be lived however one wishes to live it. Agreed. And on occassion, I have that patient who says, "Doc, I know how bad smoking is for me, and I know I'll likely die 10 years earlier, and I'm fine with that." But more often, I hear: "I plan on quitting soon, I'm cutting back right now." And then, when they end up with the emphysema, they look around shocked as they suck up health care dollars like they used to suck up cigarette smoke.

Obesity is a similar situation. People spend their 30's and 40's, maybe even 50's, saying how they love food (and believe me, I understand) and what is life without fois gras and filet (again, I understand). But by their 60's, the debts get called in, and again the shocked look as they are prepped for CABG.

Meanwhile, the non-smokers and the joggers foot the bill. (Okay, so there are studies showing that smokers cost less to the healthcare system because they die so much younger, but those are old studies and new interventions have led to longer life and greater cost. Statins alone have driven much of this. Enough with the fluoride, put some pravastatin in the water).

My point is that there is in fact a social consequence of social abandon. And in this day of fears of limited healthcare resources, can you entirely blame the person who pushes away from the table a bit earlier, who abstains from smoking, and who takes a walk after dinner when that person resents the obese smoker every time they look at the Medicare deduction from their paycheck?

Before somebody goes all hysterical on me, I am not suggesting we put the obese or smokers out to sea. But to say that their choices do not affect society is naive. If you wish to be intellectually honest and say, "Tough cookies, we all signed on to help our brothers and sisters, and if they choose to eat and drink and smoke to excess, then we will support them without judgement" then I will respect your argument, though I find it a bit moralistic to be demanding that others not judge you as you take their dollars. Isn't it enough that they are giving you the dollars in the first place? And that, I suppose, is my argument. We are, after all, a society, and we help each other. To demand that it always be done happily is to demand too much.

At Mon Jul 13, 01:33:00 PM, Anonymous Anonymous said...

I don't understand this part of the essay linked to:

"Imagine a healthcare system built around the idea that we should all engage in the habits we choose and we will have treatments for any and all medical problems that result. We would be free and clean up the mess later."

Imagine? This is exactly what we have now, not only in Medicaid and Medicare but in many private plans as well. As a fellow cancer survivor I sympathize with the writer's rejection of the notion that all illness is punishment for our "sins," but I also know that if I smoked my way into lung cancer, drank my way into cirrhosis, or ate my way into diabetes, my private health insurance (and Medicare, if I last 13 more years) would pay for the treatments to clean up the mess I created by the habits I chose.

I wish we actually had a health care system that focused effectively on prevention, instead of just paying it occasional lip service.

At Wed Jul 15, 08:12:00 AM, Anonymous William the Coroner said...

Hey, Anon 1:33-

All of those diseases, the lung ca, the diabetes, the cirrhosis all have significant genetic components. So, the exact same bad habits have different outcomes based on factors that are beyond the patient's control.

William the Coroner


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