Health Column: The futile medical care of Ray Allen, Iowa shoe salesman
MOHLER’S MEDICATION MAXIMS
Free Press Health Columnist
This is a story about favorite uncle, Ray. He owned a shoe store in a small Iowa farming town. As a teenager, I spent part of one summer helping his patrons try on shoes. Favorite uncle. Least favorite job. Phew!
Several years after Uncle Ray retired, he developed chest pain and was found to have severe coronary artery disease. Otherwise in good health and hitting the golf ball daily at age 89, he went to Des Moines where he underwent successful bypass surgery. His postoperative course was uneventful, except for a single stool sample that was positive for blood.
Why in God’s heaven they tested Uncle Ray’s stool was murky, since his blood counts stayed normal during his hospital stay. His heart surgeon referred him to a g.i. doc to undergo a colonoscopy. Ray’s nurse/wife tried to talk him out of doing this, since at his age a colon cancer would not be likely to progress to cause any problems in his lifetime. But Ray, a Navy corpsman during World War II, was accustomed to following doctors’ orders; so he underwent the colonoscopy, which showed a single precancerous lesion.
That should have been, could have been the end of the story, but since the g.i. doc was unable to completely remove the lesion, he referred Uncle Ray to a surgeon to take out the precancerous lesion. Again my aunt advised him not to do the surgery. But my Uncle Ray was a stubborn man. He wanted to “get on with life,” so he agreed to the surgery. This time he not do well after the surgery. He developed severe, progressive C. diff. diarrhea. After multiple courses of antibiotics failed to eradicate the infection, my emaciated, defeated Uncle Ray was transferred to a nursing home where he died six weeks later.
My Take: I feel sad and frustrated each time I tell this story. Unfortunately, every day a variation of this narrative of aggressive, futile, inappropriate medical care gets replayed multiple times in our country. It speaks of physicians’ needs to “fix” things. The story also highlights our failures to engage patients, particularly older ones, in the concept that sometimes (often?) the next very best test or treatment is to do nothing! As wise consumers of health care, it is always prudent to ask your physician, “Do I really need this test, procedure or prescription? What will happen if I do nothing?”
Free Press health columnist Dr. Mohler has practiced family medicine in Grand Junction for 39 years. He has a particular interest in pharmaceutical education. Phil works part-time for Rocky Mountain Health Plans. Email him at firstname.lastname@example.org.
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