I’ve noticed a disturbing trend. I just started my (thankfully brief) rotation on inpatient medicine, and before that I did two months of outpatient medicine. What has really blown me away as I work with mostly older patients is the vast difference in health between your average over-fifty person. I’ve seen eighty-year-olds who look sixty and fifty-year-olds who look like they’re knocking on death’s door. I saw one guy who was almost seventy who wanted to run 100 marathons before he died (he was on 67).
Unfortunately, he was the exception. More often I see these disasters with every medical problem you can imagine and a page-long list of medications. When did being on 4 different antihypertensives become the norm? What bothers me is that most of these medical problems aren’t caused by bad luck or bad genes, but by conscious decisions the person has made to treat their body like crap – year, after year, after year.
You may think I’m cynical or negative for blaming the medical problem on the patient, but I would disagree. I’m an individualist. I fundamentally believe in each person’s autonomy and power of their own body and destiny. It’s really the opposite of being cynical. I don’t assume people are weak, powerless victims of their circumstance. Even though some people get the short end of the stick, circumstance-wise, I think it’s much more important to pay attention to the great number of ways in which we do have power and influence over our lives.
So when people waste their power and instead lapse into damaging habits, only to take absolutely no responsibility for where they’ve ended up, I don’t have a lot of sympathy. A doctor can’t do a whole lot for someone who won’t even do basic things to help themselves. I see people who choose to smoke, eat McDonalds, not exercise, miss appointments, stop taking important medications, make excuses, etc, and have serious health consequences because of it.
If you want to smoke two packs a day, fine – each person has the right to make decisions (good or bad) for themselves. Just don’t act surprised when you get cancer or debilitating lung disease 20 years later. You can eat McDonalds for every meal, but it shouldn’t blow you way if you become morbidly obese and develop diabetes. It’s your choice. Just make sure that it’s an active choice and not a passive denial of responsibility.
I’m definitely not immune from making bad health decisions. I just ate half a bag of Trader Joe’s Cheese Puffs while I was writing this post (I think they should rename them crack puffs…). But I’m also not expecting anyone other than myself to get my fat ass of the couch and do something about it.
Anyway, that’s my rant. If you couldn’t tell, I’m definitely looking forward to finishing up my medicine rotations and moving on to my psychiatry training. Only three months left of intern year…