Patient care is easy, until it is hard.
We have a saying in my clinic. 90% of your patients are going to get better no matter what you do. 9% of your patients are going to get worse no matter what you do. 1% of your patients require you to do the right thing to improve their outcome or their prognosis.
There are zero studies that prove those numbers. A quick Google Scholar search returns zero results pertaining to the patient overall improvements or changes in prognosis based on interventions versus those with no interventions.
Appropriate perspective has to start from the premise that the majority of people are simply healthy, or only mildly unhealthy and don’t seek help in the first place. The vast majority of patients who seek medical help are sick. They are still a minority of the population. However, the body is capable of miraculous levels of healing completely on its own.
The ability for the body to respond to injury, infection, or to maintain itself in the presence of a metabolic imbalance is incredible.
With that said, the majority of people likely sustain minor injuries on a regular basis. They simply don’t seek medical care for the reasons I described above. They know their condition will resolve on its own and seeking care for it will not change the outcome. It simply adds an expense.
Still, a majority of those who do seek medical care will still likely improve on their own. If you’ve ever been provided some Motrin and instructed to perhaps wrap it, ice it, elevate it, and rest it, you may understand why now. Most of the time, nothing is required beyond that. If you keep yourself from reinjuring it, it will naturally heal most of the time.
A severely rolled ankle may indicate an x-ray, but most of the time we are ordering that simply to rule out a fracture, because a majority of them come back clean, with no sign of the break we were concerned about.
Want to know another secret? Unless your bone has exited your skin or is severely deformed, most of them require very little care either. We wrap them up and put pressure on certain aspects of the bone to keep them in alignment. That’s it. The body heals itself. By keeping it lined up we keep the bone from healing in a crooked fashion, but there is nothing we can do to fix the bone.
Even when surgery is indicated and a mechanism is placed to hold the bone together, or plates are applied to the bone to add strength and structure, it is still the bone which heals itself. Once that healing is complete, the plates, screws, or fixators can be removed, although they are often left to avoid the additional surgery.
It is also true that sometimes there is nothing you can do at all.
We all die. There is no way to avoid that fact. Some people end up with conditions, whether through bad life decisions, unfortunate genetic draw, or through circumstances outside their control such as infections or accidents, which result in a much quicker descent along that glide path to death.
We all end up at the same destination, though.
For those that are on a quicker path, sometimes we can medicate to prolong the inevitable. We can offer procedures which stall or slow down the death spiral. The quicker arrival at death’s door is still unavoidable for this group, but we can sometimes delay it for a while.
Then there are the tiny fraction of patients who need medical help, and who will actually benefit from it. Not just prolong their lives for a while longer, but quite literally extend their lives beyond a known end point to a new and much later end point.
Those are the patients that make medicine truly rewarding. When you find them and identify the problem, devise a solution and actually help them, it can make the other 99% of patient encounters fade away down the memory hole.
Other patient encounters can still be incredibly rewarding. I don’t mean to imply that medicine is only rewarding 1% of the time. Far from it. These select few, however, make all of the training, the learning, and sometimes what feels like mind-numbing repetition completely worth it.
I am naturally a bit anti-social, but patients will open up and provide very intimate details about themselves during a clinical encounter. Their openness and candor will quickly knock down any anti-social tendencies I have, and turn what would normally be a random small talk into a great conversation. What I learned from my patients is that I am not actually anti-social at all, but I’m anti fake social.
I don’t care about the weather today. I don’t care much about what you do for a living unless it is pertinent to your medical care. Small talk makes me squirm.
What I love, though, is understanding how someone views the world. What beliefs they hold or what their understanding of the world is. The forbidden topics of religion and politics are not forbidden in a clinical encounter. (Some may disagree, but I would place them in the crew that should hang up their stethoscope.)
Fears are a big component of that. Counseling people in their fear and talking them through what to expect for a surgical procedure or recovery from an injury is rewarding.
Maybe those are the topics and the conversations that make others squeamish. What they do for me is offer me social contact with people on a level that I care to engage. It is the same level that only my family and friends are most familiar with. The difference is that most of the patients want answers and are seeking solutions in addition to wanting to be heard.
It is a position of honor that they place me in when they enter my exam room, and a position that could easily be abused.
We should not find it surprising when so many in the medical profession have a tendency to condescend or patronize the views and opinions of others. Power corrupts, and it is a position of power that a provider wields in the exam room and the clinic.
I hope to remain humble enough to appreciate and respect the authority I wield, even as a physician assistant. The moment I think I know what is best for my patient, and begin to discredit their autonomy for my own goals, is the day I should no longer be a medical provider. My concern is that too many in the profession have already long abandoned any precepts of respect for their patients.
Of course, autonomy means an awful lot to me. My bias for voluntary interactions absolutely demands that a service or product offered is contingent on the willingness of the purchaser to pay for it. Medicine is not different in that aspect.
When the messaging around a vaccine has been clouded by ineffective, but draconian measures like mask mandates, economic lockdowns, and the terrible implications that imposes on a person’s life, medicine has made an egregious error. The labeling of the problem as “public health” makes them believe the errors are not to be assessed under the same microscope, but that is arrogance and not reason. So is socialized medicine.
Forcing a procedure or coercing a patient to take a medication would be akin to someone forcing you to drink tea. Requiring them to purchase healthcare through law, or nationalizing healthcare through legislation would be the same as forcing someone to drink tea against their will. The moral principles at play are not different.
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