Monday, 6 July 2015

Why doesn't medicine always work?!

All of us, one time or another, have had some kind of illness that we've needed treatment or help for. Remember when you had that nasty cold and that tiring fever? Maybe your doctor told you to take some Advil to calm the fever down. Or what about the time when your knee hurt like crazy, and you simply needed some ice to soothe the inflammation?

It's great when prescribed treatments work, isn't it? But what about when they ARE NOT effective? What happens then? We get frustrated, angry, and feel helpless. We don't understand how or why the treatment isn't working. What happens now? Well, usually the doctor will tell you to try something different. Maybe the Advil didn't work for the fever. Maybe a cold cloth will do. Maybe the ice didn't help your knee - maybe some Tylenol will work. Maybe none of this work, and you'll need to try something different yet again. 

Why does this happen? Why can't we just seek treatment for a health issue; and get it right from the first time? I'll let you in on a little secret in the world of medicine - there isn't an end-all-be-all cute or modality of treatment that works for everyone, 100% of the time. Why? For many reasons. Firstly, every patient is different. For example, we have different biological responses to medicines because of our genes, metabolism, hormones, etc. Secondly, we have differing symptoms and signs that may need specific interventions. For example, two people with asthma may complain of different symptoms - one may have wheezing each night, while another may have a cough each morning. This means that each patient may respond to a medication in different ways or to different extents.  

 
So, what are doctors supposed to do? There are published guidelines that help physicians follow a set of evidence-cased statements or suggestions for treating, diagnosing, and following-up with patients and their conditions. These are compiled after much evidence is reviewed; many professionals give their unbiased opinions, and the guidelines are tested to be effective. Are these guidelines perfect? No. Of course not. They ant be perfect - medicine is a puzzle. There are so many pieces to account for, so many factors to consider. But, these guidelines are the best resource physicians can use to help their patients. They are what normally works - and is highly effective - in many (if not most) patients. Plus, guidelines have clear instructions: physicians aren't to use guidelines without considering patient-specific factors, such as finances, genetics, motivation, presenting signs and symptoms, insurance coverage, degree of impact on daily activities, and more. Simply put, physicians  and healthcare providers are to use guidelines as one piece of a puzzle, alongside the patient's needs and abilities and resources. In this manner, physicians can ensure that patients are receiving the best care possible, the type of care that promotes their health and well-being in the most holistic sense possible. 

What can patients do? Ensure you are informed. Ask questions and help your physician understand exactly what is concerning you, what you need help with, and what your goals and resources are. Work with your physician, knowing that your physicians  and healthcare team work WITH,  and not FOR, you. And don't expect a magical cure quickly. Remember that more often than not, treatment wants need experimentation. But you can, or should be able to, depend on your physician to provide you with patient-centered, evidence-informed care. Remember: medicine and health aren't always 'textbook' cases in real-life. You aren't the same person as your neighbour, and thus, your treatment plan and prognosis (and timeline!)  might or might not be the same. But with open communication, honesty, patience, knowledge, cooperation, hope, and motivation, you and your physician and healthcare team can create a plan that suits you. This is what patient-centered care is all about.

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