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.

Thursday, November 19, 2009

Prevention is in the Eye of the Beholder

I saw a new patient the other day for a physical. No complaints, he said. He was very healthy, he said. Wellness was very important to him, he said. He was interested in being as proactive as possible about his health.

Wonderful! What more could a primary physician ask for than a healthy patient interested in being proactive about wellness?

I begin by taking a complete medical history and performing a physical examination.

Any medical conditions? No.
Ever been operated on for anything? No.
Allergic to any medicine? No.
Family history? Nothing.
Do you smoke cigarettes? Yes.

Wait, what? Health; wellness; prevention; smoker??

You will all be very proud to hear that I was in fact able to keep a straight face.

Next up is the physical, which begins with the measurement of vital signs:

Weight: 210 lbs.
Height: 67 inches
Body Mass index: 32.9
Temperature: 98.7, orally
Pulse: 74
Respirations: 12
Blood pressure: 160/100

Remainder of physical examination was completely unremarkable.

Okey doke. So what we have here is an obese smoker with an elevated blood pressure. My proactive wellness recommendations would be to stop smoking, begin an exercise program, and lose weight with a reduced-calorie diet.

It turns out that what the patient's idea of proactive wellness is a chest x-ray and an EKG.


Yes, he's aware that smoking increases his risk for lung cancer, which is why he wants the chest x-ray. This kind of makes sense (not really) but the mind-boggling thing is that he doesn't want to quit smoking.

I try to wrap my mind around this illogic (it's tough when one's brain is trying to ooze out through one's ears) and turn to the other major cardiovascular risk factor I have identified: his elevated blood pressure.

Yes, he knows that high blood pressure can lead to a heart attack. This is why he wants the EKG. No, he has no chest pain, shortness of breath, exercise intolerance, or any other acute symptom of coronary insufficiency at this time. And no, he is not particularly interested in changing his diet or exercise habits; and he doesn't think he'd be willing to take any medicine for his blood pressure (if it's still high after two more readings). He just wants the EKG. Because he's so proactive about wellness.

See what I'm up against?


At Thu Nov 19, 03:18:00 PM, Blogger Peter said...

People want to be healthy, but they do not have the effort to do so. They want a quick fix.

The only way to combat this is to have individuals realize the economic cost of continuing to lead poor lifestyles. If individuals had their insurance premiums adapted so that those with unhealthy lifestyles would pay more per month, they would quickly realize how much they could save if they change to a cheaper, healthier lifestyle.

At Thu Nov 19, 03:55:00 PM, Anonymous Anonymous said...

Would that kind of scenario best be filed under "cognitive dissonance" or "acute denial"?

At Thu Nov 19, 04:05:00 PM, Anonymous Anonymous said...

Actually, he wanted the chest xray and the EKG because he knew his insurance would pay for them.

At Thu Nov 19, 07:11:00 PM, Anonymous Celeste said...

People have crazy ideas. They think technology is preventative. This one wants tests to show he doesn't have a problem...rather than to stop doing THE THINGS THAT MAKE PROBLEMS. Why can't they understand that all a test can do is measure the damage after the fact? Instead I believe some people think it's a shield.

At Thu Nov 19, 08:45:00 PM, Anonymous Anonymous said...

this guy sounds just like me! well, i depart with him on the xray - i never wanted xrays because i didn't want the radiation. smoking tho, that's a whole 'nuther thing.

At Fri Nov 20, 08:03:00 AM, Anonymous craig said...

You can't fix stupid so move on.

At Fri Nov 20, 01:34:00 PM, Anonymous lita1857 said...

HOLY COW sometimes I can not believe what you docs have to hear.And Dino I just die when you put WTF .....I laugh and laugh.As for the insurance reference to charging higher is coming soon to a town near you! trust me I work for the dark side and they are plotting and scheme as we sleep

At Fri Nov 20, 07:02:00 PM, Anonymous ndenunz said...

I have a patient with "multiple chemical sensitivities" who smokes. Go figure.

At Fri Nov 20, 09:30:00 PM, Anonymous mamadoc said...

Oh, for pity's sake!

At Sun Nov 22, 05:58:00 PM, Anonymous red rabbit said...

It's a shame stupid isn't painful.

At Sun Nov 22, 06:50:00 PM, Anonymous Diora said...

People want to be healthy, but they do not have the effort to do so. They want a quick fix.

True. They also are so used to equate prevention with tests, that they think just having a test - regardless of whether it's shown to work or not - will keep them healthy. It's illogical, but so are most people.

I find it interesting that when I mention that my mother has lung cancer and that she is a never-smoker (from non-smoking family), some people say that it doesn't really matter if one smokes or not. When I explain how the risk of lung cancer is significantly higher for smokers, they seem surprised. Hello? I thought everyone knows that. Then there are people who say "aha, I knew we shouldn't believe that smoking causes lung cancer". So, I try to explain that it increases risk tenfold, but that small risk is not zero risk. But I really am surprised at how many people don't understand it.

At Tue Nov 24, 06:18:00 PM, Blogger Dragonfly said...

To quote from the Respectful Insolence blog: The Stupid. It burns.

At Tue Dec 01, 07:27:00 PM, Anonymous Anonymous said...

He'll be a good reason for some younger friend/relative to stop smoking, watch their weight and blood pressure.

If you have any brains you only need to deal with one aging relative suffering the long-term effects of these behaviors to make you, hopefully at a young-enough age, change your own ways.

At Tue Dec 29, 06:09:00 PM, Anonymous Qex said...

My idea? He had someone (like his wife) nagging him about his health, so he wants the tests to prove he is healthy.


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