‘SEEING A DOCTOR’
CAERS SUBSTACK ARTICLE #18
It is said that we often take our health for granted. However, since the start of the pandemic I have never during my lifetime seen so much attention paid to health care. So, it’s a good time to ask, why do people go to see a doctor? Although the answer might seem obvious, (to get better!) it is more complicated than many might think.
In my experience, there are five services a doctor can offer a patient during a visit. The first is that they can educate, because at the very least every patient should know and understand more about themselves and their body after every visit than they did before.
The second is the doctor can offer prevention, a situation in which you are healthy and want to stay that way. There are, in fact, two types of interventions that we consider preventive. The first type I refer to as ‘postponement’ as opposed to the second type which I consider ‘true’ prevention. An example of the first kind, postponement, is treating high blood pressure, or hypertension. Taking a blood pressure pill does not completely eliminate your risk of having a stroke. But if you are likely to have one at some point because of other risk factors, the medication can postpone its occurrence until you are in your eighties as opposed to your fifties. On the other hand, there is true prevention such as a tetanus toxoid injection that will not simply delay getting tetanus, but prevents it in virtually everyone who takes it. Unfortunately, a considerable amount of prevention in medicine is postponement, not true prevention.
The third service a doctor can provide is cure, where you have become ill and want to return to your previous state of health prior to that illness. Infectious diseases and trauma fall into this category. Sadly, and to the surprise and disappointment of doctors and patients alike, cure is perhaps the least common intervention we physicians can offer.
Far more common is palliation, the fourth type of intervention. We often think of palliation as something we do at the end of life, ‘palliative care’. But the origin of the word ‘palliate’ is interesting. It comes from the Latin word ‘palliare’, to cloak. In other words, we cannot cure a disease but we can ‘cloak’ it, make it less visible and bothersome. The overwhelming majority of things we do in medicine are palliative in nature, not curative. We can control your rheumatoid arthritis or Crohn’s disease, ‘cloak’ your symptoms so to speak, without eliminating those diseases entirely. Since I completed my medical training many years ago, more and more treatments for cancers tend to be palliative not curative, turning them into chronic diseases we manage but can’t eliminate.
The fifth and final service doctors can provide is to help patients grow. This includes such things as encouraging and assisting patients to control their anxiety, to re-evaluate their life priorities, to come to peace with aging and dying, or sometimes simple reassurance. Like education, ideally this can also happen at every visit.
Prevention is always very appealing because we would much prefer never to get sick at all. Unfortunately, in a complex world true prevention may not always be possible, so we have to accept that education, personal growth, postponement, cure and especially palliation are also worthy of attention.
During the pandemic there has been a lot of focus on prevention of COVID. Has there been sufficient focus on education and personal growth as well? Have some of the measures instituted to prevent COVID limited opportunities for cure and palliation of other diseases? Are we happy with the balance that has ensued? Would you normally want your doctor to only focus on prevention to the exclusion of all other services?
Having explored what doctors can provide to patients, I’ll explore how they provide that in my next article. In doing so, we might come to understand better how the pandemic has unfolded and if there are any lessons to be learned going forward.
J. Barry Engelhardt MD (retired) MHSc (bioethics)
CAERS Health Intake Facilitator
I recently mentioned at a dinner party recently, that nobody wastes their time "going to the doctor's" unless they are either very afraid or absolutely terrified of... something. I was stunned at the silence and the number of vigorous nods of approval this statement gathered. I believe that's something that you discuss in your book "Musings of a Medical Dinosaur".