Treating an Illness Is One Thing. What About a Patient With Many?
By Brendan Smialowski for The New York Times
Published: March 30, 2009
Mazie Piccolo, 84, has so many health problems it’s hard to keep track: congestive heart failure, an abnormal heart rhythm, arthritis in her knees, osteoporosis, high cholesterol, high blood pressure, gastric reflux, and depression.
What is striking about her predicament is not how rare it is, but how common. Two-thirds of people over age 65, and almost three-quarters of people over 80, have multiple chronic health conditions.
Yet people with multiple health problems — a condition known as multimorbidity — are largely overlooked both in medical research and in the nation’s clinics and hospitals. The default position is to treat complicated patients as collections of malfunctioning body parts rather than as whole human beings.
“Very often, there is nobody looking at the big picture or recognizing that what is best for the disease may not be best for the patient,” said Dr. Mary E. Tinetti, a geriatrician at the Yale School of Medicine. "And treating one disease in isolation, she added, can make another disease worse.
“As our population ages, we need some kind of overseer to juggle all the diagnoses and prescriptions and look for conflicts and duplications. This would also help to counteract the notion in many people’s minds that the doctor knows best — because often the doctor doesn’t.”
In a medical system geared toward individual organs and diseases, there is no champion for patients with multiple illnesses — no National Institute on Multimorbidity, no charity Race for the Multimorbidity Cure, no celebrity pressuring Capitol Hill for more research.
[...]
Last Post/Reflection
16 years ago
2 comments:
Interesting, you're suggesting that our obsession with specialization has led us to ignore cases and needs that require multiple specializations? That reminds me of the major choosing process and how the Interdisciplinary Fields Study Major offers us a chance to cross many fields under one study. When I finally chose my major though, I wanted a field that had a central focus, with resources that could provide a home base.
I think the article was pointing out the problems with have an overly specialized field of medicine that doesn't take a holistic approach when diagnosing patients with multiple health problems. Our specialization, while leading to advances in knowledge, traps us in a Weberian iron cage. There's a saying, "To a man with a hammer, every problem looks like a nail." Similarly, in House (medical tv show), Dr. House complains that Wilson, the oncologist (specializing in cancers), sees every patient as having cancer. The article is pointing out the problems that emerge when we just have doctors that treat parts of the body without having someone diagnose the body as a whole. So for the woman who is supposed to take 13 different medicines every day, there's the issue of how are the different medicines interacting with each other? How are they affecting other parts of her body? By using a certain kind of medicine she may be reducing one risk but increasing another, etc. The article also points out that "Two-thirds of people over age 65, and almost three-quarters of people over 80, have multiple chronic health conditions." So multiple health problems is affecting a large population, and it seems counter-intuitive, but by specializing more, doctors may not actually be helping their patients better.
-Charita
Post a Comment