I’m sitting in my kitchen in the early morning hours with my laptop and a cuppa coffee to keep me company.
Wife and kids asleep. House quiet, except the low drone of the fridge. I look outside the window and see the 50 foot tall pine trees slowly swaying in the breeze. Calm. Peace. A chance to think.
Humankind has been putzing around the planet for about 2 million years or so…domesticating and taming our environment to make this place more survivable and habitable. During that time, we’ve come to gain some experience at how to go about things while we’re here.
For maybe 5,000 years we started writing some of that stuff down so that we can transmit the experience to others.
2,000+ years since people worked out a few principles that hinted at the mechanics of how the world is structured and can be quantified.
300 years since people started being rigorous and systematic about how to test ideas and try to find the most reproducible ones. Reproducibility = Predictability
By my reckoning, we’ve only spent about 0.015% of our time on the planet living scientifically. What have we gained in the process? Well, antibiotics…immunizations…synthetic fertilizers increasing our average lifespans to more than double what they once were in the past 100 years.
But it’s not just about quantity of life that’s increased. It’s our ability to step outside our door and have some predictability as to how our days might go. The weather. The traffic patterns. Food availability. Not getting eaten by faster, nastier things.
The scientific method has given us our best chance of living predictable lives. To some, that sounds horribly limiting and boring. Well…I’ll take boring but predictable over exciting but being at the capricious mercy of “fate” any day of the week.
It’s the difference between this:
Now granted…one is clearly more “exciting”. But I know what I would want to experience when I cross the street: Light turns green…crosswalk signs says “Go”…I start walking and make it…boringly but pretty predictably…safely to the other side.
When we go to the doctor, we want 2 things:
1. A fix to a problem
2. Predicting how things will play out with or without the fix.
In doctorspeak, predicting the outcomes is called prognosis [from the Greek meaning “knowing something before it actually happens”]. We have collectively bought into the scientific method (I literally bought into it with my tuition dollars) in order to do more prognosticating rather than guestimating.
When patients come to see me regarding troublesome varicose and spider veins, I’m tasked with a pretty awesome responsibility…not “awesome” like surfer-dudespeak-awesome…awesome as in “showing reverence for”…being aware that I’m entrusted with something precious. One of the toughest aspects of this responsibility relates to prognosis.
This is a big part of why I spend 1 hour getting to know all of my new patients. I spend about half the time doing a thourough medical history and focused exam (often including an ultrasound of the lower extremities). The other half of the time is often spend teaching patients about vein disease in general and what likely led to their specific issues. Finally we spend time talking about potential treatments and….PROGNOSIS.
The first thing patients get to know about me is that I’m big on the concept of transparency: open, honest, frank discussions about the medical as well as financial aspects of their care. Simply put, surprises suck. The more we can understand all the factors at work…all of the potential risks/benefits/reasonings of procedures…as much an understanding of the murky workings of insurance carriers that we can ascertain…the less surprises.
Unfortunately, there are few guarantees in life…from the quantum to the galaxy-sized perspectives. We live kinda smack-dab in between those two. As a physician, I try to do my best to take all the data in and prognosticate based on state-of-the-art, evidence-based means.
Marrying the concepts of transparency and evidenced-based scientific methodology, I usually tell my patients the following:
1.Perfection is unattainable. Now…that doesnt mean that my OCD nature doesnt compel me to shoot for it at every opportunity. It’s just something that we all have to resign ourselves to before we even get started. There’s an old saw in medicine: “The enemy of good is better”. Every time I’m entrusted with a patient’s care, I have to weigh the benefits with the potential risks. In terms of the procedures I perform with the techniques I use and the experience I’ve amassed…the risks are low. Sometimes my role as a patient’s advocate is to say that doing nothing is better than doing something. Sometimes it’s hard to hear it…trust me, it’s harder to say it; most if not all people go into medicine to make things better by doing things. Those of us who have picked up a bit more experience along the way know that helping patients avoid risks is another way of showing you care.
2. You, the patient, have to have an idea of what “better” means to YOU. Many of my patients are plagued with annoying symptoms associated with chronic vein disease. For them, better starts with feeling better. The bonus is that doing things to make them feel better also tends to make their legs look better. The analogy I use is that just like the dentist works to make your mouth healthy…and the bonus is a nicer smile…same thing goes with treating lower extremity vein disease. How much “better”, from a looks perspectice, is realistic? I usually tell patients 70% better is pretty realistic.
3. Whatever gains my patients and I make as a team, they are going to happen gradually. Varicose and spider vein treatments are effective but require patience. Patients often have to anticipate a few months of waiting for coverage, if possible for their treatments, to be approved by their insurance carriers. They then have to anticipate that treatments are generally spaced out over a series of weeks to months. Finally, the healing process itself takes weeks to months to achieve. Honest to G-d, I wished I had some sort of eraser that could instantly wipe these things off of patients’ legs. It doesn’t exist. But…with planning…and the frame of mind that in the end things will be better…I will do my utmost to ensure that the whole experience will be as pleasant as it can be. We are going to maximize the comfort and minimize risks in every way we can.
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