Thursday, June 10, 2010

The Stupidity of Arrogance

Three weeks ago the wife of a friend had a stroke. It was believed to have been caused by an AVM, or cerebral arteriovenous malformation, an abnormal connection between the arteries and veins in the human brain most often formed during gestation. No one was aware of it before it did its damage. It has been an excruciating time for him, and the damage will take extended physical therapy and rehab to mitigate. Their lives have been shattered. In any other nation with access to the technology they had, it could have been avoided. But in this country, the "best health care system in the world" made it almost inevitable.

My friend's wife had been very ill for years. She was under the care of several specialists for an array of impairments and chronic ailments, and was given an ongoing battery of CT scans, MRIs, and other major diagnostic work for decades. Hardly a month went by that she didn't see a physician or have a test for one sytemic problem or another. On top of this she had her regular primary care doctor who saw her at least once a year. Yet throughout all this, her medical providers, rather than act as a team, were mostly islands of non-communication isolated from each other, and even when her husband tried to get them to talk to each other, he was mostly ignored. In addition, although she had complained of headaches for years (one of the symptoms of AVMs), no one seems to have thought to aim one of those many tests at her head, or to make a point of doing an angiogram. She was seen by some of the most reputable physicians in the country, at some of the most advanced hospitals in the world. In fact, the stroke happened at one of the nation's 5 top teaching hospitals, right after two consecutive surgeries for an unrelated problem, the second one done right after the first to correct a surgical fuck-up. In retrospect, great medical minds mused that the stroke may have been related to the stress of having the 2nd surgery so quickly. Hoocoodanode?

This is the irony of her tragedy: that surrounded by the best technology and brains and skill in the world, she was punished by the inevitable cluelessness typical of arrogance. Inundated with machinery, she was destroyed by the very thing that machinery was created to identify and cure, like a woman dying of thirst while surrounded by fresh water. She and her husband are now left to put the pieces back together as best they can while the edifice of technology that allowed her to fall apart chugs along with more endowments, more research grants, more awards.

These are not physicians we are producing now: they are mechanics. They are highly-skilled mechanics, and the machines they service are complicated and expensive, but they are only mechanics after all. It takes a human being to sit down and discuss symptoms, to care about patients and not just their parts, to mull over a differential diagnosis. It takes some time for that human being to get to the bottom of a difficult case that doesn't reveal itself, with a person whose mental or physical health makes it hard for them to advocate for themselves. And it takes a health care system that allows such time and encourages such interaction. What we have now is merely a factory, an assembly line of medical treatments being operated by mechanics with sonic screwdrivers. This is not medical care. It's auto maintenance done in fancy garages on vehicles that don't speak unless the machines they are hooked up to speak for them. And that's how the insurance companies like it.

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