When health becomes a DIY project
I suspect I’m not the only one who gets into trouble every time I start a do-it-yourself project. A new electrical outlet becomes a sheet-rock disaster, and the whole room has to be painted. Would have been cheaper to hire an electrictian, yet Home Depot and Lowe’s continue to do a brisk business. In medicine, there are a lot of patients who turn their health into a DIY project, which is cool when it comes to diet and exercise, but when it comes to testing and complex medication adjustment, it can be as problematic as my new electrical outlets. Thankfully, I don’t think that Home Depot or Lowe’s is gonna start a DIY Health section anytime soon.
The internet has a lot to do with the birth of DIY doctoring. A little knowledge makes people nutty. Chest pain begets a web search, which begets a list of likely diagnoses, which begets a conversation like this:
“So, how have you been feeling?”
“I think I have a pulmonary embolus.” “Why do you say that?” “Well, it could be a heart attack.”
“What symptoms are you having?”
“Do you think I should get a CT scan? My primary doctor didn’t want to order one. Or should I have a cardiac catheterization?”
“What exactly are you feeling?”
“Could it be a ruptured aorta?”
Doctors are no better. If a little knowledge is dangerous, a lotta knowledge can be outright insane.
In second year of medical school, my own hypochondria led me to believe I had every single illness we studied that year; my own sage physician would smile, hands together, and listen to me babble about my sweating, my heat intolerance, my nervousness and my insistence that I had a thyroid problem, and then say, “So are you liking the study of endocrine pathophysiology?” Things got really hairy when we got to studying the mental health disorders, each one of which I was sure I had.
DIY medicine is probably a control thing. I mean, you go see a doctor who looks like he is, what, maybe 12 years old (is too young to know what a television antenna or a typewriter is), and you tell this kid your symptoms, and tests are ordered, procedures done, you
are given meds that cause diarrhea and bloating and muscle aches, go through with testing after paying extraordinary copays, and then when you call to find out if the tests you took mean you’re going to live or die, you have to navigate some crazy phone tree, get put on hold, get transferred and then, finally, get disconnected. Who in their right mind would want to relinquish control if that is even remotely likely to happen? Meanwhile, you are still really bloated from these crazy medications that your 12-year-old boy-wonder gave you.
In fellowship, I had a mean attending who was such an uptight control freak that we would joke: if extreme pressure turns carbon atoms to diamonds, giving him a charcoal enema would make turn his lower GI tract to precious stones. He wouldn’t let you put on surgical gloves unless you did it his way, couldn’t stand if you questioned his diagnosis, and literally exploded if the ECGs were out of order in the chart. It didn’t surprise me when, late one night after fixing a patient with a heart attack, he said, like a true DIYer, “If I ever come in with a heart attack, I’m gonna put in my own stent myself because I don’t trust anyone else.” The weird thing was that, even though we all pretty much hated the guy, he actually was really really good with his patients.