All!<\/p>\n
I know I haven’t been able to shut up about my medical problems lately, but I want to call your attention to this NYT article<\/a> from a few days ago. First, though, let me express my deep thanks to everyone who offered me support before my surgery in August. I had the procedure on the 26th, was up and about the next afternoon, and am relieved to have the whole thing behind me. I created a blog<\/a> about dacryocystorhinostomy, aka DCR, aka “blocked tear duct surgery,” in case anyone who needs to have it done wants to read an account of what it’s like. The blog’s purpose is mainly to reassure anyone who’s as freaked out as I was, so I didn’t get into any deep analysis or anything – not even of the very fucked-up power dynamics of hospitals, which I got a small taste of even as a white, het, cis, middle class patient. Anyway, if anyone you know calls you up and is like, “there are stones in my tear ducts and now they’re going to operate!?” you can send them here<\/a>.<\/p>\n Anyway. The article discusses a doctor who’s trying to wean the medical profession off of its dependence on tests, and bring back the physical exam as a way of diagnosing ailments:<\/p>\n At Stanford, [Dr. Abraham Verghese] is on a mission to bring back something he considers a lost art: the physical exam. The old-fashioned touching, looking and listening \u2014 the once prized, almost magical skills of the doctor who missed nothing and could swiftly diagnose a peculiar walk, sluggish thyroid or leaky heart valve using just keen eyes, practiced hands and a stethoscope.<\/p>\n …<\/p>\n He is out to save the physical exam because it seems to be wasting away, he says, in an era of CT, ultrasound, M.R.I., countless lab tests and doctor visits that whip by like speed dates. Who has not felt slighted by a stethoscope applied through the shirt, or a millisecond peek into the throat?<\/p>\n Some doctors would gladly let the exam go, claiming that much of it has been rendered obsolete by technology and that there are better ways to spend their time with patients. Some admit they do the exam almost as a token gesture, only because patients expect it.<\/p>\n Medical schools in the United States have let the exam slide, Dr. Verghese says, noting that over time he has encountered more and more interns and residents who do not know how to test a patient\u2019s reflexes or palpate a spleen. He likes to joke that a person could show up at the hospital with a finger missing, and doctors would insist on an M.R.I., a CT scan and an orthopedic consult to confirm it. <\/p><\/blockquote>\n A few years ago, I flipped my car on an icy Iowa freeway. The car was totaled, but I got out unscathed; when an ambulance showed up, they found me sitting in the passenger seat of a good Samaritan’s car, picking windshield fragments out of my sweater. The EMTs asked if I wanted to go to the hospital and I said no, I was fine. Then I felt a rush of weakness in my neck and reconsidered. “Is this normal?” I asked. “Just come in,” they shrugged. You hear these horror stories about people dropping dead from sudden blood clots and whatnot, so I agreed. I even let them strap me onto a back board, ridiculous as it seemed, and arrived at the hospital with really no symptoms to speak of – just the weakness. I was 95% sure I was okay, but I’d just been in a car accident, after all, and wanted to be 100% sure.<\/p>\n Throughout my whole afternoon in that hospital in rural Iowa, no doctor examined me. Rather, someone somewhere ordered two X-rays and a CT scan of my neck. When the back board started digging into my scalp and I told the nurses it hurt, Dr. Whoever ordered a CT scan of my head, too (yes, I told the staff it was just the back board; no, they didn’t listen). It took a whopping 4 hours for the test results to come back, and left me with a bill of about $600 after insurance.<\/p>\n I’m pretty sure that if a doctor had just felt my neck and had me wiggle my fingers and toes, I would have been out of there in a lot less time, owing a lot less money.<\/p>\n And here’s the icing on the cake: as I lay there, having just peed into a bedpan because the nurses wouldn’t unstrap me, weeping over the death of the first car I’d ever bought myself, I received a phone call from my graduate program saying they needed someone to pick up Jonathan Lethem from the airport. Would I be interested? I’d get a free book for my trouble. True story.<\/p>\n So is the physical exam “obsolete?” Look, just because technology makes something different<\/i>, that doesn’t mean technology makes it better.<\/i> CT scans and X-rays allowed this Iowan doctor to treat me without ever laying eyes on me. Great – here’s a medal. But it was a rotten, cumbersome, time-consuming, and expensive experience that I wouldn’t wish on anyone. Is this what we consider progress?<\/p>\n","protected":false},"excerpt":{"rendered":" All! I know I haven’t been able to shut up about my medical problems lately, but I want to call your attention to this NYT article from a few days ago. First, though, let me express my deep thanks to … Continue reading