A surgeon friend sent me a book called “The Social Transformation of American Medicine.” Good stuff, but I wish there was a parallel read called “Transformation of the American Patient.” There’s no doubt that our expectations of medicine have changed drastically over the past 50-100 years.
In the emergency department we informally group patients into “sick” and “not sick.” It’s our mental triage system. Sick folks are headed south and likely to keep going that way without intervention. Sepsis, heart attack, diabetic ketoacidosis, and arrow through the neck, all make the cut.
Pharyngitis, ear infection, sinusitis, dental pain, concussion, drunk, stung by a jelly fish… all not sick, meaning they’re likely to get better no matter what we do. We may offer some tips or prescriptions to accelerate healing, and maybe some public health guidance. But mainly we’re there just to take the edge off.
Then there are the “worried well.” These are a subdivision within the not sick category. These patients want nothing but reassurance. “I sprained my ankle and just wanted to have it checked.” “My baby vomited… yesterday.” “I’ve had this bump on my shoulder for the past two years.”
Where do you land on the “worried well” spectrum? Imagine growing up in a time before antibiotics? Some of you probably can. Imagine a time before albuterol, insulin and kidney transplants. My folks can. Imagine a time before CTs, MRIs, and the STS. I can.
Patients used to expect the worst, and thank their lucky stars for survival. It’s different now. Mistakes aren’t allowed.
Unfortunately, I fear that with so many medical advances, we’ve also amplified and monetized the worried well. Worry itself has been around forever. But now that every condition has been turned into an acronym (PTSD, PVD, ED, PUD, ADD, RSD, RSS, CFS, COPD, HAFE) with an associated TV commercial, it’s hard not to live fearfully.
On the small scale, Pre-R is here to help. If you’re nervous about something, give us a call and we’ll try not to monetize your fears. We get calls fairly often now from folks who are relieved to hear it’s probably ok to just stay home and rest. Knowing that we’re available to visit if things worsen seems to be therapeutic on it’s own.
On the larger scale, however, if you have any connections with decision makers, can you please ask them to take down those daggum “direct to consumer” medical ads from the TV?! We’re one of very few nations that permit such lather for the worried well.
