Sunday, December 09, 2007

I am not dead, Blogosphere!

Okay, so I did not post at all in the month of November. This is partly because life is very boring. (The good kind of boring, where you're happy, but nothing to blog home about, so to speak.) Things got busy at work and I have learned that although I think I've been very careful and have excellent attention to detail, there is nothing you can do to catch every mistake when reworking a medical form. I cut and forgot to subsequently paste questions. I missed numbering errors. I capitalized and italicized inconsistently. But lucky for me, there were a lot of people looking at it and I think we've caught everything now. (hahahaha!)

But this process, and the process of doing cognitive interviews about the form with actual patients, has lead me to really think about "health" - as an abstract - and about how social convention both helps and damns us. On the latter, because patients seek out their physician and their physician's advice, they will do pretty much anything the physician asks them to. Fill out a 13-page form? Sure! Answer the same embarrassing question four times? Why not! This is great for physicians because it allows them to quickly and easily get the information they need when they need it. Because they aren't wasting time explaining why patients should follow instructions or rereading a chart looking for one piece of hidden information they could easily ask for, they're brains are free to think about the patient's condition and to develop an autopilot for making diagnostic connections. On the other hand, patients will sometimes suffer through humiliating or painful procedures because they trust their doctor so implicitly. Why wouldn't you ask what something is for, why it's being done, why this piece of vital information can't be ascertained another way? Every patient I interviewed said the same thing about the incredibly long form: "I'm sure it's useful to the doctor. She wouldn't ask if she didn't need to know." When it comes to the doctors I'm working with, that's absolutely the case - you couldn't ask for more dedicated or caring specialists. But this is a general statement; it's not really about the physicians asking the questions; it's about any physician.

This brings me to "health" as an abstract. What is wellness? How do we define when we're well? What does it mean to be well? I think a major component of "health" is fear. You live every day in your body: shouldn't you know it better than anyone else? And yet it does so many strange things, for which there is seemingly no explanation. Finally, one of the strange things causes you concern, you know that you don't personally have an answer, so you go looking for one. And for most people, in that fearful state, unsure of what their symptoms mean, whoever they see first is who they see period. No matter how good or bad that physician is (and honestly: how would we tell the difference without being physicians ourselves?), most people will never question him/her or seek out a second opinion. And if you're a problem patient - someone who comes back repeatedly with the same mystery complaint, who believes in health fads, who's on the internet 24/7, who brings literature with them to the doctor's office - you will sometimes be given a catch-all, meaningless diagnosis because they don't know what's wrong with you and just want you to go away. Fibromyalgia. Interstitial cystitis. So long as there's a technical-sounding name, they can even make something up. And for some people, this works. Sometimes it really is psychological, and all they needed was a name for the condition and then suddenly the supplements or exercises or diet-changes take effect. And how is that not a cure?

What part of health is purely psychological? Don't we all rely on physicians to do fear-management and to help us understand what the emotional burden of our condition will be? I think an argument could be made that 95% of health is psychological. You can have a physiological problem, testable and visible to a trained professional, and not feel a thing. Are you then well or unwell? You could have achy joints every day of your life from birth, but that's your reality, so it isn't until you're an adult that it becomes clear that most people do not expect their joints to ache after sitting for more than an hour. Were you well or unwell before your realization? Are you any more well or unwell now? Our expectations for "wellness" are sometimes defined by our community, sometimes by the media, sometimes by personal experience and sometimes by our physicians. Is one right and another wrong? How is anyone supposed to understand wellness? How can anyone argue that there is an objective wellness?

These are the things that I've been thinking about. My guess is that they'll roll around in my head and ram up against specific problems and examples over the next couple of years. Hopefully that will help me decide what I want to do vis-a-vis a PhD program. If the questions become solid enough where I'm dying to experimentally explore them, then I'll want to go back to school. But if they stay amorphous like this, I'm not sure what good more school will do. Do I really want to get a PhD just to determine if something is measurable?

1 comment:

Joseph said...

I'm glad you're not dead!

I think that the world is entirely a manifestation of my subconscious, therefore all of health is psychological. Hah!