More is magic
I travel through daily life protected by a veil masking the unforeseen that might befall my loved ones and me. Unfortunately, the veil temporarily lifted during a single week in December when my wife entered my office, shaken, after a mass was discovered during a routine exam; days later, I received a call that my daughter, an avid cyclist, sustained a concussion requiring a two day hospitalization in San Diego (she was wearing a helmet); simultaneously, I began experiencing vision irregularities in my lone good eye.
Unprotected and vulnerable, I longed to prevent and control the occurrence of harmful circumstances. Throughout history, humans have felt this same desire expressed through incantations, prayer, sacrifices, ritual dances, magic and superstitions to ward off the “evil eye.” In health care today, this universal need emerges as an almost magical belief that “more is always better” and “knowledge is power.”
Knowledge is power; uncertainty can be eliminated. Surely more tests lead to greater certainty. Often, multiple testing generates even more uncertainty through “false positives” (an abnormal result when no abnormality exists) or “false negatives” (a normal result despite an abnormality).
An explanation exists as to why I feel this way. Sometimes, with a medical evaluation, uncertainty reins supreme.
A reason exists as to why I developed this problem. The probability of developing conditions such as specific cancers, diabetes and heart disease increases with risk factors related to family history, smoking or obesity. Yet, people may succumb to illness with completely unknown origin.
Early detection of problems leads to cures. Although sometimes true, early detection provides no guarantee of improved prognosis.
Don’t just stand there, do something! Treatments can be ineffective or produce deleterious side effects eroding the quality of life. “Watchful waiting” may at times remain the best course.
The recent announcement that nine major physicians groups have identified 45 medical tests and procedures that are often performed unnecessarily demonstrates the need to rethink certain commonly held assumptions in health care. Most medical tests are necessary and important, but we’re beginning to understand that some common medical tests are overused.
As the United States tackles reducing unnecessary services (medical services without obvious benefit and with the potential to do more harm than good) we must begin with compassion toward patients and their families. If we are asking patients and their families to shed the illusion of control, to travel the unknown and experience uncertainty, then we have a responsibility to provide them with something other than the “magic” of “more is better” — something real such as healing relationships with our clinicians and other team members who offer quality care rooted in the best evidence. And while we provide high quality, evidence-based medicine, we must also understand that bound-up in the longing to control and ward off harm, is the need to have faith and hope.
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