I am at a stage in my life where I am well into reflecting upon where I am and how I have gotten here. For anyone who has read at least representative previous blogs, you will have almost certainly picked up a certain libertarian and laissez faire streak in the way I look at the world, including how I see the role of medical care. I am very much an advocate of aggressively dealing with symptomatic and impactful problems that affect patients and very skeptical of attempting to address problems that might happen to populations of well patients if it means doing things to people who are well at the time of the intervention.
In thinking back upon my exposure to the medical community while growing up, it was very limited. I was basically healthy and I went to the pediatrician perhaps once a year, at most. If I were injured or suffered some non-life-threatening situation (which is essentially all encompassing in my parent's perspective), we deployed something OTC and sent me to bed, assuming that it would be all better after a night's rest. I recall one particular episode when I was perhaps 15 years old when I was playing a pickup game of football (tackle) in the rocky school yard. We had recently moved to a new city and I was all excited about developing friends and "street cred". I fearlessly three myself into the activity until I suffered a profound blow to the head, the unfortunate consequence of friendly fire. My own teammate hit me with his knee to my temple when I was tackling the runner from the other team.
I was struck with such force that it knocked me unconscious briefly. When I came to within a few seconds, the world was blurred and I was wobbly kneed. Ultimately I ended up with two blacked eyes. Later in medical school I realized I may have suffered a basilar skull fracture, as evidenced by the blackening of the eye on the collateral side from the blow. I got a ride home, still wobbly from the accident and explained the situation to my father who as far as I can recall was rather nonplussed. His solution to everything was the same; 222 tablets, purchased across the border in Canada. The consisted of acetaminophen, caffeine, and a modest dose of codeine. I took two, went to bed, and was up the next morning ready to go to school where I had immediate credibility based upon the dual badges of honor I wore. I could take a punch.
The assumption in my family was that episodes like this were not the province of the medical community. No specialists or specialized tests were required. No q 2 hour neuro checks were required that night. Everyone got a good night's sleep, me included. Was my family management of my sandlot football injury reckless? Would my parents be reported to child protective services now if they did not take my current day equivalent to seek professional medical care? I am sure there are well documented anecdotes where children in similar circumstances has less than desirable outcomes which might have been forestalled by timely interventions. The question in my mind is whether these examples warrant moving more and more of the management of these into the professional medical arena.
I wish I had actual data (I always do) but I suspect that we more heavily use professional medical services at a higher rate across all age groups and perhaps across economic tranches than we did 30 years ago and certainly more than we did when I was growing up more than 50 years ago (I give away my age...sort of). Are we better off from this?
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