Thursday, July 28, 2011

Medicine isn't about blame, it's about treatment


Yesterday this blog saw a guest posting from Lillian, a Nova Scotian who fears she'll likely die before she reaches the head of her province's 10 year cue for bariatric surgery.

A great many folks left comments (both here and on my Facebook page). Some were supportive. Some were full of self-righteous indignation. Others I chose not to publish as they were incredibly rude and hurtful.

The bottom line for virtually all of the upset commentators was that Lillian just ought to do something. That she ought to fix this problem herself. That clearly she'd just given up. That she wasn't trying hard enough.

It was the good ole, pull herself up by her bootstraps and take things into her own hands crap, or a variant of I did it, so so can she, and while I'm thrilled for the folks who've experienced their own successes, they don't necessarily translate to others.

For readers who don't know, I'm not a surgeon. I'm the medical director of a behavioural weight management program. And while I've seen with my own two eyes many a person lose enough weight to preclude surgery, I don't delude myself into thinking that downloading the solution to extreme obesity onto personal responsibility is everyone's answer.

If there were a non-surgical, reproducible and uniformly effective plan for the management of extreme obesity, I'd agree with you, but the fact is, there is no such plan.

Of course, even if you do want to embrace personal responsibility as the sole cause of obesity, medicine isn't about blame. We patch up drunk drivers and folks who don't wear seat belts. We offer smoking cessation programs. We treat asthmatics who don't bother keeping up with their puffers, pneumonias exacerbated by the early discontinuation of antibiotics, and the psychotic breaks of folks who stop their antipsychotics.

Oh, you want surgical examples?

How about lung reduction surgeries in smoking induced emphysema; liver transplants in former alcoholics; or how about one that doesn't involve a so-called vice at all - heart bypasses on folks who simply didn't bother to take their blood pressure, cholesterol or diabetes medications?

We operate on them all in a timely manner, and so we should, and the public doesn't generally say boo.

But yet in the case of bariatric surgery, many people are up in arms about its timely provision.

Why?

Because for obesity, many folks feel justified discussing its treatment on the basis of blame based causation.

The thing is, aside from obesity it would seem, medicine isn't about blame, it's about treatment, and if there's a proven and viable treatment option, at least here in Canada, people believe it should be readily accessible by our heavily taxed population, regardless of how and why their conditions developed in the first place.

At the end of the day, Lillian rightly sees bariatric surgery as hope. Emotionally it would see her bolstered by a success which for whatever reason, and it's not for anyone to judge, you haven't walked in her shoes, has eluded her. Economically it would save Nova Scotia likely tens of thousands of dollars of care and may improve the Province's GDP by increasing Lillian's ability and duration for gainful employment. Statistically and medically, it will prolong her life, cure her diabetes and sleep apnea, and potentially provide her with a springboard to retool her world, meet her grandchildren, and enjoy a fuller life.

Can you think of any other area of medicine, with an equally dramatically effective treatment option, where people would feel comfortable preaching about personal responsibility trumping a patient's desire or right to access said treatment?

I sure can't.

Lillian shouldn't have to wait 10 years on a wait list for a gastric bypass, and blame has no place in the ethical practice of medicine.

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