Wednesday, March 9, 2011

PLAYING IT SAFE


I was chatting with a friend in line in the post office. She told me that a couple of weeks ago, hiking with friends, she'd gotten dehydrated and fainted. She recovered in a few minutes. The group continued its hike and returned home uneventfully. When she told her husband, a nurse, what had happened, he insisted on bringing her to the local emergency room to check her out thoroughly.

She was examined, had an MRI, blood tests, and, "…just to play it safe…," was observed in the hospital overnight. A physician she'd never seen before visited her there. He said, "If you fainted, you shouldn't be driving. I've asked the Department of Motor Vehicles to suspend your license." The medical workup turned up no findings, and she went home the following morning.

She was in the post office to send off forms requesting restoration of her driver's license. She wasn't pleased by her hospital experience, especially its expense since they were uninsured. She asked me, "What do you think that whole thing cost?"

Knowing how insanely expensive American healthcare is, I facetiously guessed fifteen thousand dollars.

She said, "How did you know?"

What's to be learned from this debacle? When we want to "play it safe," how safe is safe? At what point do we accept risk and, ultimately, mortality?

We tend toward applying full-bore medical technology in every case for a couple of reasons. First, it's available, so what the hey, especially in those instances when someone else pays for it. Second, it seems to be the responsible thing to do. What if, God forbid, we miss the…(fill in the blank)? Third, if you really love your spouse who fainted, you'll leave no stone unturned.

Still, this approach is more often troublesome than helpful, as medical investigations can be confounding. We need to remember, for example, that all diagnostic procedures bear false positives and false negatives. CAT scans can show "tumors" that don't actually exist, and miss tumors that imitate normal structures. The same is true of the physical exam and every conceivable test. When a false positive occurs, it doesn't announce it's false, of course, so it can generate further testing. And just because a test result is "normal" doesn't necessarily mean everything's hunky-dory.

There are ways to approach this conundrum with better balance. Here are a few recommendations:

1. Become more knowledgeable medically. Do you know, for example, that dehydrated hikers can faint? Do you know how to treat a sick kid's fever?

2. Accept that it's impossible to guarantee perfect safety. You already do, to some degree: everyone draws a line they consider reasonable. E.g., hardly anyone wants a series of pulmonary function tests when they have a cough.

3. Be aware that other folks, drawing different lines, might ignite your fear. Your nurse spouse might insist you go to the E.R. Your doctor might want to run a few tests, "just to be sure."

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