Prairie Doc® Perspectives for week of December 25, 2022
If it sounds too good to be true
By Debra Johnston, M.D.
At my house, classic TV is a given. My 93-year-old father-in-law enjoys watching reruns of westerns, Perry Mason, Andy Griffith, and Gomer Pyle. With these old favorites come commercials targeting an aging population: Medicare Advantage plans, reverse mortgages, and “miracle solutions” for neuropathy, with free consultations for the first 250 people who call!
Every time we see one of these neuropathy advertisements, my father-in-law looks at me hopefully.
His neuropathic foot pain has been intractable for decades. All the usual medical solutions have either brought minimal relief, or intolerable side effects. It interferes with his sleep, and the shuffling of his feet in response to the pain literally wore holes in the dining room linoleum.
Any situation without a clear solution leaves an opportunity for the unscrupulous to pounce. As I watch those TV ads, I wonder how many people send in their money or otherwise fall victim to medical quackery.
Years ago, I accompanied a friend to a hair loss “consultation”. He was awed by the trappings: white coat, scientific sounding terms, glossy pamphlets with patient testimonials. I was less impressed. What was in their product? They couldn’t tell me, it was secret. Where were their studies? They pointed to those patient testimonials. Did they have any published data? That wasn’t available yet. I was struck by the scientific babble, too. It sounded impressive, but it didn’t make any sense to me.
Today similar organizations offer invitation-only dinners at local establishments, followed by the opportunity to sign up for treatment that may cost you out of pocket because insurance won’t cover it. They have professional looking websites with quotes, supposedly from delighted customers, and perhaps a few references to publications doctors might call “throw away” journals, or to decades-old articles, or research that doesn’t actually involve the treatment at hand. There might be claims that the treatment is ancient, or brand new, or that “they” (usually doctors, the government, or Big Pharma) don’t want you to know about it.
Legitimate medical treatments are not kept secret. They are presented to other professionals, for critique, evaluation, and replication. Researchers try to determine if a treatment might be effective only in certain situations, or more broadly. If it is promising, it becomes widely available, and insurance coverage often follows.
Sadly, neuropathy, like many chronic pain conditions, has a variety of causes, and a variety of often less than satisfactory treatments. It is an easy target for “snake oil” salesmen. As always, talk to your doctor before you try something that sounds too good to be true.
Prairie Doc® Perspectives for week of December 18, 2022
Advances in surgery
By Debra Johnston, M.D.
My son is one of the many Americans with cleft lip and palate. The specifics of each affected individual’s situation vary, but one thing they have in common is that they will be having surgery. Lots of surgery. Although most individuals with orofacial clefts, including my son, are otherwise healthy and lead normal lives, the process of restoring a normal smile, normal speech, normal chewing, involves many steps from birth into adulthood.
Most of his surgeries have blurred together in my mind, however, his first bone graft remains starkly vivid.
In this surgery, bone is removed from the hip for implantation in the ridge under the nose, where your front teeth are anchored. The pain where the bone was removed was excruciating. He was hospitalized for four days, and once home we struggled to keep him comfortable despite acetaminophen, ibuprofen, and two different opioids.
We were understandably dismayed ten years later to learn he would have to undergo this procedure again. Not enough bone had grown from the earlier graft to support the next stage of the repair.
It was with great trepidation that we checked into the hospital for surgery earlier this summer. Despite the reassurances of our surgeon, we both expected the same gauntlet we had faced last time.
We were wrong.
In the intervening years, a new delivery system for an injectable anesthetic had been developed, and then approved for use in young people. His surgeon used this medication at the graft harvest site. The difference was almost inconceivable. He needed minimal supplemental pain medication during our single night in the hospital, and once discharged took only the occasional dose of Tylenol or Motrin. I suspect those doses were prompted mostly by the fear that it might start to hurt more, and not by pain itself.
Like all of medicine, surgery has experienced change at an ever-accelerating pace, but the apparent “revolutions” are built on a foundation of step-by-step science. In medical school, I watched the first laparoscopic nephrectomy performed at the University of Iowa, a major tertiary care center. This amazing “new” technology could trace its history back nearly 200 years, to a German doctor who invented a primitive precursor. Advancements in both medicine and technology have brought us to today, when endoscopic, laparoscopic, and robotic surgeries have become commonplace.
The path to developing new techniques and technologies may not be smooth, but we are the beneficiaries of pioneers and scientists who move medicine forward. I am grateful for them all, as a doctor, and as a parent.
Prairie Doc® Perspective week of December 11th, 2022
“The Two Sides of Humanity in Medicine”
By Jill Kruse, DO
Merriam-Webster defines humanity as “compassionate, sympathetic, or generous behavior or disposition.” It is also defined as “the quality or condition of being human.” The first definition is what people want in a health care provider. We all want to be taken care of by a caregiver who is compassionate, kind, sympathetic, and generous with their time and knowledge. Health care providers spend countless hours taking care of patients. In order to do this, at times we ignore our own needs for rest, sleep, and food. We recite mantras of “first do no harm” and “the patient comes first.” Many of us strive for this vision of the “perfect” provider or to be a “health care hero” as we were called during the pandemic.
Unfortunately, all health care providers are also the second definition. We are all human. That means we make mistakes. We get tired and hungry. We get angry or can be afraid. Despite being called heroes, we often do not feel heroic or even act heroic. We may say the wrong things in the wrong way. We could hurt patients with our words or actions. This is not done intentionally or with malice; it is a side-effect of the second definition, being human. Most health care providers desperately want to only be the first definition, yet it is easy to find examples of times that we have failed.
These two definitions do not need to be at odds with one another. The first one has been praised and encouraged to be shared by health care providers. The second definition has, until recent years, been suppressed. Each generation of health care providers strives to be better than the one before. Now there is specific training in medical school teaching how to admit mistakes that one has made and sincerely apologize. Medical students are not graded on just their knowledge of disease and ability to diagnose, they are also graded on their ability to communicate and interact with patients. The art of “bedside manner” is something that can be taught. However, it takes a career to truly refine that skill by making mistakes, identifying them, and learning to be better the next time.
Allowing health care providers to show both of our sides of humanity – the good and the bad – will allow for more trust and greater connection with the very people we are trying to heal. That connection will, in turn, heal the health care provider. This mutual healing will help us tap into the compassion, sympathy, and generosity that make us human and drew us to this profession in the first place. Together we can heal and be better, by seeing ALL of the humanity that we all share.