It’s been a busy news day in health over at the New York Times. There are two good articles to read. The first is yet another great piece on the lack of benefit found for stents and stable coronary artery disease, and the second is by Dr. Gilbert Welch about the fallacy that early disease detection is always a path to better health.
I can tell you that the mantra of early disease detection is driven into the psyche of every doctor during our training. As a medical student I always felt a little queasy about the hunt for invisible disease. It was one of the reasons I chose emergency medicine because I thought (somewhat mistakenly) that the only patients who come to the emergency depart are really sick (they don’t feel well, as opposed to being one of the worried well). But even in my chosen field I can’t escape the most challenging of all patients. The one who looks fine and feels fine.
The sole reason for this is that there is a voice in the back of my head telling me that if I don’t find any disease it must mean it escaped my detection, and that I have failed my patient. I imagine to myself that in a week, six months, or six years that patient will go to another doctor and they will find a tumor, heart problems, or a myriad of other diseases, and they and their new best friend Dr. Ifoundit, will say “if only that doctor in the ED had discovered your problem sooner you wouldn’t be in this predicament!”
But what if finding that disease in someone is simply a gateway to anxiety, fear, painful tests and procedures, and a hefty bill rather than a longer or better quality of life? Suddenly Dr. Ifoundit is not looking so smart.
These articles are a great reminder to patients and physicians alike that the forces pushing for the detection of disease and the forces for better health are not always perfectly aligned, and that if we choose to build our health care system on the former rather than the latter we may find ourselves individually and collectively on a long and painful road.