Skip to main content

Goals of modern medicine

What are the goals of modern medicine?  
A.k.a. the answer to my daughter's question "daddy what did you do today?"


A very wise and humble cardiologist I apprenticed under had a simple answer: the role of medicine is to treat and prevent symptoms, events and death.  You can fit pretty much every piece of health advice, treatment, surgery, and medication into one of these roles, or at least you should be able to.

Symptoms - the things we feel.  Like when our knee hurts because of arthritis or we cough because of a cold.  They are the physical manifestations of a process going on in our body.  Telling people to maintain a healthy weight and regular exercise can reduce the symptoms of arthritis and washing our hands regularly and covering our mouth when we cough reduces the chances of getting symptoms from a cold virus.  But some things don't always have symptoms like high blood pressure, high cholesterol, or kidney damage.

Events are major occurrences, generally things that wind us up in the hospital.  These are usually the physical presentation of something that doesn't have a lot of symptoms.   A heart attack or a stroke is a presentation of longstanding high blood pressure or high cholesterol, a hip fracture is a presentation of osteoporosis, a fainting spell can be a presentation of an ulcer or a cancer or a heart arrhythmia.  Massive resources are spent treating and evaluating these conditions because people end up in the hospital for them and so even more resources are spent trying to prevent them from happening in the first place.  But we as a people or species just don't do a good job of recognizing the long-term effects of short-term behaviors.  For examples, look basically anywhere in a newspaper.  Except for climate change, which we all know is a complete hoax because we recently changed our opinion of what facts are.

Death - it's going to happen.  Hopefully not too soon.  This is probably the toughest one to see gains in but one of the most important things research studies look at because while you can have varying opinions as to whether someone had a stroke or why someone ended up in the hospital, it's a lot more black-and-white as to whether somebody is dead (I guess there's also mostly dead. "Mostly dead is slightly alive.  With all dead, well, with all dead there's usually only one thing you can do ... go through his clothes and look for loose change."  10 points if you get the reference.)  For instance, screening people more frequently for prostate cancer may lead to fewer deaths related to prostate cancer, but people still end up dying at about the same rate , usually from something else that pops up, which is why there's so much debate about prostate cancer screening.

So you should always think about these goals whenever I or anybody else recommends anything for your health.  There are some websites that delve a little more into the relative value of various medical treatments you might want to take a look at

- The Choosing Wisely website or app can help you make informed decisions about your health.

Choosing Wisely was developed by the American Board of Internal Medicine (ABIM) Foundation and Consumer Reports to help patients explore options and choose care that is supported by research, safe, and medically necessary.

Go to http://www.choosingwisely.org/patient-resources/ and search for conditions, tests, or procedures, or browse the Lists for Patients.

Download the Choosing Wisely app from the App Store.

- The NNT (Number Needed to Treat) is a good website I like that puts a lot of the research studies and recommendations into numbers I can more easily digest when I think about the relative value of things.  If you're interested in more data based info, this is a good site:  http://www.thennt.com

Popular posts from this blog

NSAIDs

Advil and Motrin are ibuprofen, then you have Aleve (naproxen).  Those are the over-the-counter ones.  Prescriptions are Mobic (meloxicam), nabumetone, indomethacin, Toradol (ketorolac), diclofenac, Lodine, and the list goes on.  All of these medications are in a class called non-steroidal anti-inflammatory drugs (NSAIDs). I'm giving you this list because there is mounting evidence that these medications a) don't work as well as we'd thought and b) have some very serious long term side effects we're finding out more about. NSAID's act by reducing the amount of prostaglandins you make in order to reduce inflammation.  However, prostaglandins have a ton of other effects and are involved in the maintenance of just about AIDs and also stronger if they are taken every day and/or around-the-clock.  every other organ system that you have.  The effect is stronger with higher doses of NS NSAID's work best and are best indicated for times when something is r...
Read more

Kidney Stones

I've written about this previously , but it's often hard to explain to people what a 10 is on the "1-10" pain scale if they haven't been in that spot before.  For women who have had children, they generally know what a 10 is, but for men it's a little harder.  When I was a medical student on my psychiatry rotation, we had a patient calmly sitting there saying his pain level was at a 10 and our resident, who was an ex-military sniper with a large skull tattoo on his forearm and a crosshair through the eye, calmly leaned forward and asked, "so if I lit you on fire and ran you over with my truck, you could not be in more pain than you are now, correct?"  The patient changed his answer. Getting to the point, a kidney stone is about the close I can come to describing a 10/10 pain to people who haven't gone through childbirth.  The fundamental issue is similar - your body is trying to move a big solid thing through an opening that was not really desig...
Read more

Pain

Sorry to be a pain I would say about 90% of the comments I hear from people about their pain threshold is that they think they have a high pain tolerance.  Which is statistically impossible unless I just attract people who have a high pain tolerance. We traditionally ask people to rate their pain on a 1-10/10 scale and while we hear a lot of 9's and 10's, I would say that, having been present for a number of them, a 10/10 would be giving birth to a first child.  For those who haven't experienced that, my old psychiatry resident described it as "so if I lit you on fire and ran you over with my truck, you would not be in any more pain than you are now" (he was also a former Marine sniper which might explain that). But this is pretty pervasive throughout the medical system and got me wondering as to how people's understanding of what their pain threshold was matched up to what it really was.  Fortunately, there were researchers who had a yen to poke peopl...
Read more