Are We Really Fixing Things by Pat Conrad MD
In the middle of my shift the other day, I encountered a patient typical to the ER. A forlorn appearing, mildly distressed female with chronic recurrent nausea and vomiting, often accompanied by a vague, hard to pinpoint or reproduce, abdominal pain. Of course, she had been the recipient some years back of a gastric bypass.
In the 5 rural ER’s I rotate between in the Florida panhandle and southern Alabama, I almost never work an entire shift without seeing a patient status-post gastric reconfiguration. The majority of these are obese, and a few are fairly thin. None of them ever appear to be either healthy or happy (granted, they are in the ER, but still …).
I perceive we have created an age in which more and more often physicians do not counsel and guide toward improved lives, but “fix” things in the short term with scalpels and pills. Who in any clinical field has not noticed the legions of children on ADHD medicines, chemically zooming through their formative years to what end once the pills run out or are removed? How many children by parental neglect, physician co-dependency, and downright societal license, have been deprived of the necessary experiences through which they might have developed compensatory behaviors and talents, further depriving us all of new ideas, arts, speakers, leaders, and happy minds who might have come to know selves borne of better confidence?
A long-time colleague noted a few years back that, ironically, the gastric bypass surgery alters the function of the one organ system previously shown to be working properly. I think that’s better philosophy for a profession sorely in need of reexamination. What will the long-term complication rate in this patient population look like a decade from now?
Agree with Dr Pat. Wish we could clone you and put you in every clinic.
It’s amazing how much our medical system damages patients.
As a Child Psychiatrist I get fed up with people knocking the use of medication for ADHD. I’ve lost count of the number of children I’ve seen who were failing in school but when put on the right medication they get on the Honor Roll. It’s been the most gratifying part of my psychiatric work.
Ditto,
Heck, if the kid does well, it’s working. If not, nobody is putting a gun to anyone’s head to keep the kid on a med they don ‘t need. One has to try something else.
Good essay. You’re right, too many people want what appears to be the easier, softer way. It comes back to one of your other themes: the healthCARE process is increasingly driven by entities such as Wall St., insurance pimps, etc. As long as profit remains the ultimate value, providers and patients will suffer. There’s no scientific/rational reason to say healthCARE should primarily be a business.
Yes there are many problems with pre and post bypass patients. What does this have to do with ADHD ??
The connection I’m suggesting between the two is that they are both grossly over-utilized interventions – one surgical, one pharmaceutical – resulting from the unwarranted demands of patients, and their doctors’ often inappropriate acquiescence.
Cripes where I’m at, it takes a year for a morbidly obese
to wend their way through the system and indoctrination before they “get” their procedure. That sounds cautious to me. Only thing I notice is that the public aid patients have a higher failure rate as they don’t have to put up $$$$ or jump through any insurance hoops. The folks that have to invest all or some of the cost, generally follow the rules and are less likely to subvert the procedure. They do better. Last I heard the failure rate of bypass was something like 37% though. Failure being gaining the weight back after losing it by stretching the pouch out.
I say send ’em all to North Korea as they don’t have any food. Plus the starving people will probably chase all the fat butt Americans around with meat cleavers trying to get ’em in the stewpot. After the surviving fatties lose the weight, we give ’em a plane ticket home. If the North Koreans offer to send ’em back on a rocket, I suggest the now thin “fatties” don’t accept it as the Koreans don’t do very well with rockets.
New evidence out about high rates of alcoholism postbariatric surgery too. Yesterday news that long term costs are not reduced (at least in VA males) in post surgery people. Hear lots of anecdotal evidence about multiple complications, regain, etc. but STILL does not the majority of evidence say most baraitric surgery people do well and thrive with less sleep apnea, diabetes, etc. ? Quality of life scores are supposed to be much better too.