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?

Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  8 comments for “Are We Really Fixing Things by Pat Conrad MD

  1. big picture doc
    July 21, 2012 at 6:36 pm

    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.

  2. Brian W. Joseph, M.D.
    July 18, 2012 at 9:52 pm

    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.

    • Kurt
      July 19, 2012 at 2:10 pm


      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.

  3. July 18, 2012 at 10:19 am

    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.

  4. John Parkin
    July 18, 2012 at 9:48 am

    Yes there are many problems with pre and post bypass patients. What does this have to do with ADHD ??

    • Pat
      July 18, 2012 at 10:25 am

      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.

      • Kurt
        July 18, 2012 at 4:21 pm

        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.

  5. Mike
    July 18, 2012 at 8:59 am

    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.

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