Everyday somebody somewhere summons a plumber. The drain is blocked, the boiler isn’t working, there’s a leak under the sink. The problem is obvious the solution is technical and everyone knows when the job is done. If it’s not fixed asap the plumber is sacked.
That’s rarely what it’s like in medicine. Not everything is a blockage or a break. Not everything can be fixed by sitting quietly with a tool box and following the instructions in the manual.
Many of the commonest problems in healthcare don’t have an easy fix.
- The pain of ‘tennis elbow’ can last for months despite treatment
Patients with tennis elbow can be reassured that most cases will improve in the long term when given information and ergonomic advice about their condition. Bassett et al.
2. Plantar warts don’t always respond to cryotherapy
Little evidence exists for the efficacy of cryotherapy and no consistent evidence for the efficacy of all the other treatments reviewed. Gibbs et al
3. Lung cancer is incurable in most cases
Lung cancer is the main cancer in the world today, whether considered in terms of numbers of cases (1.35 million) or deaths (1.18 million), because of the high case fatality (ratio of mortality to incidence, 0.87). Parkin et al.
4. Anti hypertensives aren’t guaranteed to prevent stroke
Our analysis indicated that the absolute benefits of antihypertensive therapy depended on BP as well as the presence or absence of additional cardiovascular disease risk factors and the presence or absence of preexisting clinical cardiovascular disease or target organ damage. Ogden et al
5. Mild depression can be hard to treat
The magnitude of benefit of antidepressant medication compared with placebo increases with severity of depression symptoms and may be minimal or nonexistent, on average, in patients with mild or moderate symptoms. Fournier et al
6. There is no cure for the common cold ( You don’t need a link for this)
These and most other problems in healthcare cannot be ‘fixed’. They can be diagnosed and they can be ‘managed’ but they can’t be fixed in the way that faulty plumbing can be fixed. Therefore that queue of people in the waiting room is saying something more than ‘I’m here to be fixed.’ Patients are saying:
- I am in pain
- I am anxious
- I am unhappy
- I am bored
- I am angry
- I am confused
- I am lonely
- I don’t like my job
- I can’t pay my bills
- I need tablets or surgery
The job of the doctor is to work out which and then to fix what can be fixed and help the patient to live with the rest until their perspective or their circumstances change.
- Most people won’t take their tablets as prescribed.
Because non-compliance remains a major health care problem, high quality research studies are needed to assess these aspects and systematic reviews are required to investigate compliance-enhancing inteventions. Let us hope that the need will be met by 2031. Vermeire et al
- Most people won’t benefit substantially from health promotion advice.
Exercise-referral schemes have a small effect on increasing physical activity in sedentary people. The key challenge, if future exercise-referral schemes are to be commissioned by the NHS, is to increase uptake and improve adherence by addressing the barriers described in these studies. Williams et al
3. Most people get better in spite of treatment and not because of it.
Disease mongering can include turning ordinary ailments into medical problems, seeing mild symptoms as serious, treating personal problems as medical, seeing risks as diseases, and framing prevalence estimates to maximise potential markets. Moynihan et al
But then most people will be deeply grateful to their family doctor because they don’t have to respond a certain way to be treated with respect and they don’t expect a ‘cure’ and won’t ask for their money back when things don’t work out. The doctor’s role is to be there, to encourage, to educate, to accept and to walk with their patient through all the challenges that life has to offer.
Picture by Vicki