The disillusionment of “healthy” patients.

In Editorial, Opinion by Edmund Kwok1 Comment

Guest post by Linda B.

After spending years in both the Emergency Room and the Intensive Care Unit, I have come to realize that we do a grave disservice to the Canadian Public…people think they are healthy.

People think that if they wake up in the morning, swallow a handful of pills and go about their daily lives, they are healthy. Despite the fact that our lives are generally sedentary, we eat too much, drink too much, and exercise too little. Far too many of us take a pill for something, and think nothing of it.

In fact, we think so little of taking our daily medications that many people presenting to the hospital cannot list their own medications, or say exactly why they are taking them. This phenomenon is not limited to the elderly, and it includes people in their 40s who lead productive lives and are otherwise successful intelligent individuals. They take their meds because their health care providers told them to – with no understanding that those pills represent at least one chronic disease that we are treating.

There is also absolutely no understanding that a chronic disease has a trajectory. That trajectory more often than not will lead to complications, changes in quality of life and in the event of a life threatening illness will contribute to the shortening of their lives.

In an article published by BMJ in 2006, Davidson and Simpson point out that “patients undergoing dialysis typically do not view themselves as terminally ill and falsely assume they can be kept alive indefinitely on dialysis“. These are patients who at least three times a week have hemodialysis and they do not view themselves as having a life limiting illness.

With amazing frequency people who have “the big three” – hypertension, diabetes and hyperlipidemia – and have been living with them for 20+ years are admitted to the hospital. I’m not talking about the three pill kind either. I mean the ones who have had difficult-to-control disease processes. The ones who already show kidney failure, have abnormal echocardiograms, and other signs of vascular compromise.

These people who have never been told that they are not well. They still think they are healthy. And unlike the patient on hemodialysis there is no easily graspable evidence to the contrary.

We are so cautious as to not limit people’s hopes that we forget they have to live with the sequelae of their illnesses. After all, the consequences are not ours…or are they, in our public healthcare system?

There is a need to make sure that people, at some point, understand that while the pills that they take may keep their bodies functioning well, the pills will only work for so long. There is a need to meet pill-taking in the middle. A need to recognize that bodies will fail, beyond any point where we can fix them.

Often at family gatherings, the topic arises of who takes what pills. This is frequently followed by the boast “my numbers are now perfect, I should just throw these pills away”. It is at this point that I tend to feel obligated to remind my family that the reason their “numbers” are good is because they take the pills, not in spite of them. That those pills may keep their measurable numbers normal, but they do have a chronic disease that is being treated.

As healthcare providers, it is our pronouncement that “the numbers are normal” that encourage this complacency. We neglect to talk about the natural trajectory of chronic disease. We often even accept numbers that are outside of normal as “good enough”. Each passing year that you take medication to control a chronic disease, your body is continually changing in response to the disease – certainly not the changes if you chose to not take the pills, but it still changes.

It means something when you go to the hospital and say you take medication that says “I have diabetes, high blood pressure and high cholesterol”… even if you don’t seem to understand what that means. It means, that perhaps for a very long time, you have lived with chronic disease. And yes, we have worked hard to keep your numbers normal, and to keep you symptom free for as long as possible.

We have not, however, explained to you that your chronic disease will eventually affect your ability to heal from other life threatening illnesses. We check your labs annually, make sure the numbers are “normal”, briefly talk to you about your weight, your quality of living, and you say it’s all ok. Year after year, the same thing happens. And we know, that each year the numbers are off a little bit more, but we’re ok with that. We know the trajectory, we know the outcome, and we’re ok with that, we’re willing to accept that consequence. But do you even know that there is a consequence?

We have allowed you to walk around believing that taking your pills faithfully will allow you to eat what you want, drink what you want, and weigh what you want. That you do your part, you keep your appointments with your health care provider and we pronounce your numbers “normal”. You go on, living your life, with no understanding of what, other than the pills you take, will make you healthy.

And by all rights, smiling, tanned and driving your cart around the golf course – you look healthy to me too.

Author Bio: Linda B is an RN, certified in Critical Care and Emergency Nursing . . . who in the near future will be a Nurse Practitioner and will join the ranks of those health care professionals who are willing to not only be primary care providers but also believe in exceptional primary care for all Canadians.

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Edmund Kwok

Edmund Kwok

Emergency Medicine. Quality Improvement. Patient Safety. Change Management. Healthcare Administration.
Edmund Kwok
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Frontdoor 2 Healthcare

Frontdoor 2 Healthcare

Frontdoor2Healthcare, founded by Dr. Edmund Kwok in 2012, provides editorial and commentary on issues affecting Canadian healthcare from the emergency department’s “front door” perspective. Frontdoor posts allow for open sharing of the diverse opinions and perspectives of emergency physicians from across the country.
Frontdoor 2 Healthcare

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