Didymos Thomas wrote:
I take Aedes' point - if we can prevent some ailment, that is far better than a cure. But, when prevention is difficult or when prevention is not completely successful, cure is important.
You can't prevent everything. You just can't. And sometimes it's not worth it. I mean if everyone cut off their balls then there would be no testicular cancer, right? Sounds silly, right? Well, people with certain congenital abnormalities who have intraabdominal testes DO have them removed because the risk of cancer is so high. Some women who are at extraordinarily high risk of breast cancer elect to have prophylactic bilateral mastectomies -- Christina Applegate just did it. For people at lower risk, mammograms and breast exams are a legitimate way to screen for
early signs of breast cancer, thereby preventing it.
Screening tests are part of prevention. But the implications of these tests are critical. I mean some give false positives, which causes people unneeded stress, unneeded tests, and unneeded operations -- that's why these total body CT scans that some people advertise on the radio are ridiculous.
Dependent on an elite body of institutional research and rebuffed and debased semi-important insight, the role of 'care' is minimalized in the context of specialist knowledge.
Yeah, that's exactly how my day went. I had 13 patients in the hospital today -- for one of them I spent about 45 minutes to an hour talking to her and her family about communication with one another in order to help her get support for her drinking problem. That is preventative medicine -- it's secondary
prevention so she doesn't have another problem. For another, an undocumented immigrant with a life-threatening infection, I spent god knows how long communicating with social work and other agencies to get emergency coverage of his hospitalization, and then explaining it all to him in Spanish which is a second language for me. For another I made a million phone calls arranging outpatient appointments, communicating with other physicians for a smooth transition of care. And then I paid a social visit to a boy who I saw as an outpatient last week who is now sick in the hospital, just to say hi and see how he was doing. I sat down in every room I was in, didn't answer any pages while talking to them, and did not leave until specifically asking them whether they had any other questions for me that weren't answered.
Everyone I know does the same things for people. And you know, I'm a subspecialist, though I happen to do a lot of work on a general medicine service. I could easily spend 2 minutes in a room, do a perfunctory physical exam, and then go out and order this or that medication. But part of care is having an ally in your patients -- treating people who are informed about their illness and know exactly why we're making certain recommendations.
I find people who sit around waiting for customers, when the customers understand their rights and a decent bit of medical information, the staff react; when customers present themselves as 'silly' yet seriously ill, so many doctors prescribe 'medication' - when in my opinion residential 'sex' clinics would make more sense in the long-term.
I don't have the foggiest idea what you're talking about here. But you're an awfully crass cynic, and I'd bet that if you spent a day hanging out with me in the hospital or in the office, you'd have a different idea of how medical care is delivered.