Last week’s column described five statements that I call “Medical Truisms”.  They describe rules of behavior for healthcare professions and patients in order to achieve harmonious effective outcomes.  In today’s world it seems lists always come in 10’s like “The Top Ten Reasons For ….”  So here are the other five medical truisms.

     Medical Truism # 6:  “In the medical field, things are rarely ever simple”.  Medical knowledge is like an inverted pyramid.  The amount of information about how a disease works and what might be done to reverse the problem continues to grow.  If you can believe it, in a 1910 textbook of medicine the prescribed treatment for stomach ulcers was broth enemas.  A number of other medicines were also prescribed which today we know to be poisonous.  We didn’t have a clue as to what caused ulcers.  But we knew that people with ulcers were usually anxious and we kind of fell into the belief that ulcers occurred because the person was anxious.

     Today, we know that the stomach has a protective lining that may allow ulcers to occur when that lining is disrupted.  We understand a number of factors in our society that do disrupt that lining and we have learned that the basic problem in stomach ulcers is an infectious process due to a bacteria that infects the stomach lining and can be treated with an antibiotic.  I guess probably a hundred years from now there will be other information yet.  But the point is, what we once thought was a stomach ulcer caused by anxiety we now know is an ulcer caused by infectious bacteria.  The evolution of knowledge to reach that conclusion was a long complicated story. In medicine things are rarely ever simple.

     Medical Truism #7:  “In medical considerations, things are rarely ever easy.”  In today’s busy world, we have computers that deliver answers in an instant with the push of a button.  By comparison, patients would like to have instant answers with easy simple solutions to health problems.  Sometimes, a lady will present with an uncomplicated urinary tract infection that can be treated with an antibiotic very easily; but all too often multiple other considerations enter because the infection is recurrent or associated with kidney stones or associated with a leaky bladder, etc. etc. etc.  Patients and healthcare professionals need to be very careful to give apparently simple easy problems adequate, thorough attention.

     Medical Truism #8:  “It (he, she, they) never upset you.”  One of the most common phrases heard in a healthcare professional’s office is, “It upsets me.”  The person can be talking about the neighbors dog, her husband’s driving habits, his or her lack of considerate behavior, Junior’s CD player being too loud, etc. etc. etc.   Based on our own values and beliefs, people labor under the delusion that the world and people in it must adhere to our beliefs and standards.  What a delusion!  We cling to the idea that by expressing our anger and displeasure to other people, they will immediately change their behavior and start doing what we want.  We go through life, believing that our upset serves a constructive purpose for us because when we get upset, other people will change their behavior.

 Now think about it.  The last time somebody became upset with you over something that you thought was your right and privilege to do, did you immediately change what you were doing to satisfy their upset?  Maybe in a perfect world, considerate people would change their behavior to satisfy other people’s needs and perceptions but in my experience that is rare.  As I pointed out in previous truism, nobody ever does anything wrong, so why would they have to change what they are doing.

 One of the best pieces of advice that I know is to recognize that your upsets, your joys, your sorrows, are all your own.  You chose your own emotions based on your own values.  Nobody ever upsets you.  You chose to be upset.  The beauty of this truism is that you can quit being upset anytime you want to.

     Medical Truism #9:  “When what you are doing doesn’t work, do anything else.  Don’t keep doing what you have already shown doesn’t work”.  This statement is so obvious as to not even be worth mentioning and yet in the field in medicine it is one of most defied and neglected truisms that I know.  Both health care provider and patient will frequently adhere to diagnosis and treatments that simply aren’t working and never will. There needs to be recognition of the need to change.

 A recent example of this was a lady who had a disease called rheumatoid arthritis.  Over many years time, she had used an over the counter medication called Motrin (Ibuprofen) to treat the pain of her rheumatoid arthritis.  She indicated that it was a poor solution and she hurt terribly in spite of it but had been told that this was an arthritis medicine and she should take it.  Motrin is a common cause of stomach ulcerations and bleeding which happened to this lady in a very dangerous manner.  She was told she needed to stop the Motrin and use other products to relieve her pain.  But it was her belief that she didn’t want to become “addicted” to pain medicines.  So on three more occasions in the next year she came back to the hospital with bleeding into her stomach because she took the Motrin again.  I was finally able to convince her to try a product called propoxyphene which is a pure pain medication with a very, very low addiction potential.  Propoxyphene does not cause gastric bleeding, works on command when you take it and is in fact a much more effective pain medication than Motrin.  Finally, I was able to convince her to make this change and cease using Motrin.  But it took four hospitalizations.  When what you are doing doesn’t work, be willing to try something different.

     Medical Truism #10:  “Properly planned and delivered medical care is safer than disease”.  In today’s world, our media spectacularize medical misadventures.  In the last year, an unfortunate child got a heart transplant at Duke University but with the wrong blood type and she died.  Medical misadventures do occur.  The delivery of medical care is not perfect.  But what received negligible attention in the media blitz on Duke University was that the little girl was going to die of her heart disease if she didn’t get a heart transplant.  Disease is dangerous.  Medical care is designed and directed to be safe and to combat disease.  The lives that have been saved with proper surgical intervention, antibiotics, heart medications, kidney dialysis, etc. etc. far exceed the lives that have been lost through medical mistakes.  The rule here is to carefully think through, plan, and carefully monitor medical treatments but do not neglect a disease for fear of medical care.