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?