Saturday, August 6, 2011

The Good Life vs. the Long Life

A couple days ago a fellow JMS (junior medical student) and I were conversing. Yes, I am aware that my posts have all lately become medically-oriented; heck, who're we kidding, it's been this way for most of the last couple years, lol. Anyway, we were conversing about the kind of doctor we want to be - one who helps patients live a longer life, or one who helps patients live a better life (as in, better quality of life).

If you had to choose one, would you choose a good life or a long life? Of course ideally we'd want both and patients often demand both. But try as hard as they can, they're only human and in the short run will almost always sacrifice a potentially long life for a good life. This got into a discussion of medical philosophies. In medicine we can do many things to prolong life but often at some cost of a good life. In some surgical specialties, such as orthopedics, they work on getting people back to their normal baseline or in some cases improve upon that - that is, an increase in their quality of life.

It's not easy being a patient. Some of my friends simply don't understand that. You can't just tell a patient to take xyz drugs for their health problems and expect them to be even 67% compliant. It's not easy taking 5+ different medications every day, each of them taken at different times and some with certain conditions/restrictions. It's easy to forget which ones you've already taken and which ones you forgot to take. On top of that, you have to maintain a more restricted diet and have a exercise regimen at all. Because, as we all know, medications only gets us so far; the rest of the way is all on our own. And with each pill we have patients take, with each side effect they may present, we decrease a patient's quality of life in order to increase their lifespan. One could argue that we increase quality of life over the long term too, but in the short term it still kinda sucks.

So is there some way to have one's cake and eat it too? Yes. In pediatrics, the general rule is that kids are usually healthy. The goal (in primary care peds) is to keep kids as healthy for as long as possible, and hopefully transition them into healthy adults. The other JMS who's on the same service as I am this month currently has a patient who's about my height but weighs 198kg . . . That's over 400lbs!! This morning I just looked at her (the patient) and thought, "If I hollowed you out, I could fit about 3 of me inside of you."

This woman also has some young kids, all of whom are normal-sized for their age. The other JMS recounts to me, "Did you see her kids? They're all normal. No kid starts out life that fat. What's the difference between them turning into her? Oh yeah, 18 years."

So if I truly desire to go into peds, I have about 18-21 years to prevent my patients from turning into their parents and developing the same health problems their parents either have or will have. It's possible. It won't be easy, but it's possible. I don't think we honestly try hard enough to counsel patients on preventative medicine - eating right, exercising, not smoking, cutting back on drinking, safe sex, etc. It's difficult in primary care, I know, what with the 15-20 min office visits. That's practically impossible! But we must still try.

Perhaps I'm being too idealistic. I wonder if it'll all crush me.

I'm meeting Drew for coffee tomorrow. Perhaps this time I'll dredge up the courage to tell him how I truly feel about him. Hmm . . .

I'll let you all know how it goes, maybe . . . lol.


Max said...

I like the med oriented tangents! they give me something else to read about besides peoples day to day problems which, although valid, get bland over time. Personally I am a live your life rather than preserve it guy, perhaps because I already overindulge in food and the such but if I was too afraid of disease or something like that I wouldnt be able to go abroad or anything like that. And I plan to see a bunch of countries yet :) or at least as many as I can before that bus hits me....knock on wood! Quick! hahahaha

the island guy said...

Your posts sounds like something that could be used in an episode of Grey's Anatomy haha. I really and wholeheartedly don't know much about the world of medicine, but it sure does sound interesting.

robert said...

I wish it was really possible to have such a probing convo with an MD. Watching death and dying up close on a number of occasions, I really question the use of more procedures and more meds as a default response for an organism WITH a life SPAN. Doctors wanted to treat breast cancer in my 96 year old mother last year! Are you serious? She refused and died at home. My partner died from HIV related diseases and was taking 16 medications when he died. 16??!! How can this possibly be a good thing? I hope you will always keep a healthy skepticism of the establishment, the AMA, FDA and most every profitable incentive which might impact your ability to do the RIGHT thing by the patient.

Aek said...

Max: Lol, thanks. Most things in moderation and somethings in abstinence, hehe. As my mom aptly says, "We've only got one body and our health. Gotta take care of it."

the island guy: Lol, I don't know about that. There's not enough sex in my posts for Grey's Anatomy. :P

robert: I'm sorry to hear about your mother and your partner. :-( Those are end-of-life discussions that should have been made with the doctor. At that point, it's definitely better to consider hospice and just making the last days as comfortable as possible. And insofar as HIV, medications have come a long way. 16 pills for HIV would be quite rare these days.

I don't have a skepticism of the establishment. I treat it as I would anything else in science. But this is where medical science ends and medical art begins. The one thing doctors still don't know how to do well is letting patients go with grace because for too long, doctors saw themselves as the last bastion before death. It's not for profit that doctors try to do all they can for patients, and often times patients demand such interventions. Sometimes the right thing is also that which the patient doesn't want.

international online pharmacy said...

Yeah is really hard to say because you will never do what kind of patients you will get and will have to give people bad news, so is really or maybe you will become an ass and will care just about money...