Medicine just in case
My healthcare needs are complex and as I navigate Polish medicine (mostly private, as almost half – yes, half, Poles), I am fascinated by how it’s done. This blogpost is an account of three consultations in the last month or so.
Let me remind of the context first, though. In a number of posts, I wrote that the key difference between how Polish and British doctors do medicine can be subsumed by their attitude towards errors. British doctors are more afraid of the false positive, their Polish counterparts are more afraid of the false negative. That it to say, Brits are worried they will discover an illness that there isn’t there. Indeed, time and again, in Britain, I was told to do ‘watchful waiting’. This course of action is supported by a much-celebrated text called ‘The art of doing nothing’. Iona Heath, the author, makes an impassioned case for having the courage of doing nothing.
I always wonder what happens when the patient gets much worse, but I guess, it’s tough. When I saw my GP after my myocardial infarction a few years ago, he seemed genuinely pleased. The smile and his happy ‘It’s finally happened’ suggested that I offered him relief. He was, after all, right. He seemed to have been waiting for my heart attack to congratulate himself on a job well done. Now he could do something and he did.
In contrast, in Poland, Polish doctors seem to assume that they are visited only by ill people. And so, they go out of their way to do ‘something’. This means you get prescriptions of medication ‘just in case, you need it. Obviously, you may well not, but if you do, it’s at hand. ’ve been told many times that I should take the pills only when I get worse, or when I feel I need them. Medicine ‘just in case’ is a matter of course. The same happened in the last three visits – I have been prescribed medication which I should keep ‘just in case’. And there is an interesting reversal of watchful waiting here. In Britain, you wait to see whether you need the medication, in Poland, you wait to see whether you indeed don’t need it.
But something else happened too. I went to see a specialist, my first visit. It went relatively well, the doctor was very happy to explain things, I got my prescription for the medication I needed (and one for medication I might not need). And as we were making a follow-up appointment, I was told to do a number of tests. It was said something like:
Oh, please do test A, and you may as well to test B. Hmmmm, have you ever done test C? No? Oh, why not do that as well. Just in case.
I must admit that I was both bewildered and amused by these requests. First, the lackadaisical manner in which it was said was surprising. The doctor was naming the tests off the top their head. This was not a list which was considered (or guidelined), discussed, and explained. Rather, it was something that was occurring to them as we were saying goodbye. I immediately thought of the ‘just-in-case’ medicine, as I do more and more tests. Indeed, I thought, if you do enough tests, you are bound to find something.
Don’t ask as you might find out, I was told recently by a friend.
The second train of thought that was pushing into my head was that I would be the one paying for all those things. The doctor’s fee was reasonable (below the going rate at the moment), but as it was a private visit, I will be paying for everything, having already spent about 50 quid on the tests preparing for the visit. So, the question whether I need those things is also one of whether I do need to spend the extra money on tests which are not within doctor’s specialism and were requested ‘just in case’.
The social aspect of this is not lost on me. Yes, the almost 50 per cent of Poles who attend private medical care, which is extremely common in Poland, are the 50 per cent who can afford it. And they do it because of access, quality of care and several other things. But it also means that more than half can’t afford and with the rising cost of living, many struggle to pay for medication they were prescribed.
But there was one more thing that came to mind. I juxtaposed this with my GP practice in the UK. Every test was like pulling teeth, looking at it from all possible angles, mostly deciding that it should not be done just yet, some more waiting was justified. So, money is not only the ‘Polish’ concern – every time, I was wondering whether the GP wouldn’t request the bloods because he wanted to be frugal in his practice of medicine.
Here, the decision is mine. I don’t have to do them; the doctor is unlikely to ask me about them – my choice. Moreover, with all that going in my mind, I thought the doctor was showing care. The ‘occurring to them’ was not chaotic, haphazard. They were wondering, in the context of the visit, what else might be needed to make sure that I am offered good medical care. At least this is what I thought.
Let me put it differently. The moment you recast the just-in-case tests as making sure that I am OK, as prevention, if you will, they make better sense. The doctor I saw was very experienced and so, they probably know better….I just wish, I had been told why I should do the tests. The problem then might be more of communication not medicine.
So, as all this was going on in my head, I did bottom-lining, I have come up with two bottom lines. First, I prefer to ‘do something’ and not wait until I came with a pancreas problem (one of the tests I was requested to do was a pancreas test). It’s now years ago that I waited so long for someone to deal with my fatigue that I am very unhappy to be told to wait for things to happen for the doctor. Second, as the doctor knew who I was and likely made assumptions about my financial status, they probably also assumed that I could afford the tests.
And finally, I read the ‘just in case’ medicine mostly in terms of caring. Let’s not waste time for another visit, you are an adult, you can decide whether to take the additional medication, if I tell you when. Same with the tests – they offer the medic a fuller picture. Yes, some of the picture might be unnecessary, but is it not better to be safe than sorry? Medically, I don’t know, individually, I know it is. In the case of my GP trying to dismiss my chronic fatigue, there was never any explanation. It was always: I don’t think you’re ill, underpinned by: and I decide. I still remember the time as one of extreme frustration.
But there is one final question. Does it all mean ‘too much medicine’ – although the hype seems gone, it’s still, I think, the worry of British medics. So, does my doctor do ‘too much medicine’? I have been thinking about how to answer the question for some time and every time I have come up with one answer:
I don’t care. I feel taken care of.