Poor Predictors

There are probably plenty of healthy people out there who don't take medications and don't see doctors. If, however, this is you, and you end up in the ED, and you're over the age when people normally start taking meds and seeing the doctor--say, forty--then these are bad signs.

Any other major medical problems? No? Any medications? No? Next question, always--do you see a doctor regularly or are you just in denial?

Alternative health nuts would say the western system is based on ilness not health blah blah dangerous medications blah spirit healing and so on, and for some, sure. If it works, great. But...

If you come in with a smoking history, painful lumps in your groin, axilla, and on your shoulder, and you have a cough, and you've lost twenty pounds since february, and you wake up soaking the sheets...sorry, dude. Giant, metastatic lung cancer for you. Now granted, lung cancer has no accepted screening. But maybe, just maybe, a family doc actively trying to get him to quit smoking might've made a difference. I sure didn't--outside of delivering the news as compassionately as I could.

He has a nine month old daughter. Damn, damn, damn. Add not smoking to helmets, please.

And to highlight why we get so paranoid--he had been to two EDs prior to this, and had never gotten a chest x-ray. Of course, he hadn't had four weeks of illness at that point, either. The last doc ALWAYS looks the smartest, but they have the easiest job. Catching it on the first go round? Now that's genius.


Resident 3521.237B said...

Tyro, are doctors supposed to convince people by scaring them half to death? "Tobacco, late-stage lung cancer, gruesome death; get the picture, Patient #3542563H?"

Such tactic seems all too common in our society, for the purpose of "getting your point across, fast," i presume.

tyro said...

I think it's more selection bias; that is, we only see those people without prior medical care who HAVE something terrible wrong. We never see those who are fine. Thus, we associate these stories with bad outcomes. When I'm counseling someone, I usually don't try to scare them outright, but you're right, it's common. I also posted to vent. This guy made me sad.

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