Modern Medicine --- The Good

I recently posted a couple of entries detailing some medical mistakes and what we can do to protect ourselves from such things. Today's post is about the other side of our medical establishment and the care we receive.

We've all heard about the nefarious uses of chloroform and ether, but when I had my tonsils removed in the late forties, ether was the medical anesthetic of choice. The use of chloroform as anesthesia had pretty well ended by that time because of the number of accidental deaths. Ether had a reputation for safety so was used almost exclusively until the fifties. Now we have dozens of anesthetics ranging from inhaled to intravenous, short term to long term, local to general and combinations of various kinds. Some are quick acting, some maintain their effect over longer periods and some are designed to promote amnesia while allowing a person to be responsive to a doctor's orders.

Similar improvements have been made in diagnostic tools. When I went in for my first physical the doctor depended on a stethoscope, reflex hammer and his own senses. I donated a urine specimen which he smelled and eyeballed for color and cloudiness, matching those attributes to standard charts. I don't think he tasted mine but if a doctor suspected diabetes, he would taste the urine to determine its sweetness, a pretty good indicator of diabetes.

Doctors today have access to dozens of blood tests, MRI and CT or CAT scans, XRays with immediate results via digital methods, endoscopies (upper and lower), EKG and StressEKG tests and echo scans from fetus to old age and often concentrating on the heart. Speaking of the heart, there are tiny cameras and surgical instruments that can be inserted into an artery or vein thereby looking at and treating the heart from the inside. Then there are very sensitive microscopic tests and even DNA tests.

Surgical techniques also have changed for the better. The old "sawbones" has become a specialist equipped with a wide array of instruments to perform amazing medical feats. 

When my appendix was removed in 1960 I was left with a four inch scar. With today's laparoscopic surgery (sometimes called minimally invasive surgery) there would be only a small dimple. 

Prior to 1950, if you had an arthritic knee or hip, you learned to walk on crutches, operate a wheelchair or stay at home.  In 2009 there were 773,000 hip or knee replacement surgeries just for Americans. Of course, there also are replacements for ankles, elbows and wrists. Today's recipients of artificial knees and hips are often out of the hospital in just a couple days. What an amazing improvement.

Then there are the medical specialties. A hundred years ago there were only a few specialists, today the American Board of Medical Specialties lists Specialty and Subspecialty Certificates for which they can give certification. There are 26 specialties with up to 20 subspecialties under each specialty.

With this number of specialists and the many diagnostic options available, any patient worth his insurance can have up to a dozen specialty doctors and a huge file of diagnostic procedures. In my own case, I’m pretty healthy but at times I see my primary care provider, cardiologist, dermatologist, endocrinologist, gastroenterologist, neurologist, ophthalmologist and sports medicine specialist. If I need to go under, that calls for an anesthesiologist as well.

All these improvements lead to better medicine and longer lives. When I was born in 1939 my life expectancy was 62.1 years, if I had been born in 2010 my life expectancy would have been 76.5 years. That’s a remarkable improvement in 71 years.

Doctors are better trained, tests are better, anesthetics are safer and surgical procedures are more effective with better outcomes. Some doctors tend to over test and over prescribe. Over testing is often driven by the specter of malpractice lawsuits, justified or not, and over prescribing is driven, at least in part, by the ubiquitous advertising of Big Pharma urging watchers to “ask your doctor if this magical drug is right for you.”

There are some problems, as there must be with any system as large as our medical program. If I were in charge I would make a couple changes. I think people make better decisions when they have some skin in the game. Somehow we need to let people feel a little of the economic impact of medical decisions. When medical care is given at no cost to the individual we see cases of sniffles in the emergency room and sore backs in the doctor’s office with the owner asking for an operation.

Sometimes the best course of action is no action while letting the ailment cure itself, as ailments have done for thousands of years. Maybe with a little help for old wives and their time-tested remedies but without knives and operations with questionable results and certainly without wonder drugs that are rapidly losing their power to cure fast evolving microbes.

Overall I’m impressed with the progress of medicine and medical professionals during my lifetime. No system is perfect and medical professionals are human, but by and large the system is better, the doctors are more professional and people are living longer, healthier lives. It doesn’t get much better than that.