Sunday, November 22, 2009

It's All Relative

As a family doctor, I talk with people all the time about doing things they don't want to do, but that are ultimately good for their health.

Helping people quit smoking, for example, occupies a lot of my time. And it's a challenge. Smoking tobacco, after all, is the perfect designer drug. It stimulates, it relaxes, and it's lightening fast--flushing through the rich pulmonary vasculature in a heartbeat. There are a number of effective medicines that help people quit, but all-in-all, you have to do it yourself. One of my patients figured out that at seven dollars a day, she'd parlay that destructive habit into Puerto Vallarta in less than a year.

Of course, there are other habits that require consideration: lack of exercise, overweight, alcohol dependency. Nobody wants to change their habits! As a doctor, you can point out the benefits, but people have to come to their own conclusions to make changes happen.

Then, there's the colonoscopy: routine colon cancer screening which usually begins at age fifty. The procedure itself is painless; I watched my own procedure on the screen with no discomfort. The prep the evening before is inconvenient; I recommend a varied assortment of clear liquids and a good supply of reading material--you won't be going out that night. Over the years, I've learned it takes about three discussions to persuade people to get their colonoscopies done. So now, I start talking about it with people at age forty-seven!

I implore my patients to get their mammograms, and find the most recent preventative recommendations (starting mammograms at fifty) to be unthinkable. Most women don't welcome their mammograms, finding them either uncomfortable or inconvenient. But early detection means better, longer lives.

Controlling diabetes and high blood pressure --the two main causes of End Stage Renal Failure--requires vigilence on the part of patient and physician. No doubt Steve would have traded the inconvenience of  being more vigilent on the front end for the inconvenience he suffers now.

The other day, I was talking to one of my patients who is about to begin training for Peritoneal Dialysis, with overnight treatments done daily. And I'm sitting here writing as my husband snoozes during his Home Hemodialysis, imapacting our schedules nearly five hours a treatment, five days a week.

It's interesting to me as a physician and as a dialysis assistant how difficult it is to cajole people into doing the preventative medical procedures that really do help--often with inconvenience as the main objection. Relatively, these tasks seem pretty inconsequential when compared to dialysis.

I'd say Steve and I are heavily into "inconvenience." But there's no getting around it: he gets to live. And we're both so grateful for that.
Take care. Linda Gromko, MD

No comments:

Post a Comment