Friday, 14 November 2008

Honesty is the best policy

As I write this, I am convalescing following an important (albeit minor) but painful diagnostic procedure.  There is no need to go into detail save to mention it is now apparent to me, that despite several thousand years of perceived wisdom it is, after all, possible to pass an object which feels roughly the size of a camel through something roughly the size of the eye of a needle providing sufficient lubrication is employed.

To distract myself from these delicate proceedings I began to dwell on the events and the reasoning that had led up to this day, the final stage in the investigation of this particular medical problem.  Making decisions about medical matters is not easy.  There are strong emotions to contend with - fear of the unknown, fear of pain, worry about family and friends.  There is denial; would I prefer not to know the full picture, just in case it’s something serious?  Also anger; I still consider myself young (don’t we all?), what have I done to deserve this, it’s not fair?

Fortunately my doctor was all you would hope for; extremely pleasant as well as knowledgeable and professional.  He was obviously experienced in this area of medicine and in dealing with this type of (not so patient) patient.  Aware of my worries he took time to explain carefully what was going to happen, the risks involved and the benefits to be gained in the way of good diagnostic information.  He was able to give me an idea of how I might feel during the procedure based on first hand reports he had had from previous patients undergoing the same thing.  He was also able to call on scientific studies to give an idea of the suitability of other routes of inquiry open to me.  From studies in larger patient groups he was able to advise that more invasive means of investigation probably weren’t called for at this stage given the risk of complications and the likelihood that, since all other tests had so far proved normal, little extra would be learned.

He explained, between my nervous interruptions, about the drugs that would be used.  Local anaesthetic with its familiar, predictable mode of action, well understood by those who use it and supported by decades of research allowing scientists to modify and improve the drug to give better pain relief and a varying duration of action, depending on requirements.  Antibiotics too, since their discovery in the 1930’s have been studied in sub-microscopic detail and classified, catalogued, refined and improved upon resulting in the saving of uncountable millions of lives in the few decades they have been around.  Pain killers also have come a long way since their beginnings as willow bark infusion taken through pursed lips to treat a headache.  Thanks to diligent research they are now more effective yet safer than ever before.

Of course it is the way of the world that most useful things in life have drawbacks as well as benefits.  Take mobile phones for example.  They save lives in disaster situations but when you’re next to a person ostentatiously broadcasting the more inane half of their high decibel conversation they are a complete pain and if used inappropriately, such as when driving a car, can be lethal.  In minor medical procedures such as mine the “risks” are equally minor; some pain or discomfort, the possibility of a little bleeding, all of which would be expected to resolve of their own accord within a day or two.  In other cases however where the stakes are higher the risks of treatment may be proportionately increased too.  This is the so called risk-benefit analysis which is core to any sensible decision in modern medicine and surgery.

Crucial to such an analysis is a full and honest understanding of how medicines and surgical procedures work and of all their actions on the body, not just the desirable ones we are hoping for.  The key word here for me is “honest”.  We live in a fast moving technological world containing many wonders which only a few decades ago would have seemed almost magical and some wonders which to many people, myself included, appear magical right now.  But they aren’t magic, they are made possible by an understanding of the way the world works and how the things in it from galaxies to quarks interact.  There is so much to know we can’t all understand everything, that is to be expected and it’s why, sometimes, we have to rely on experts who we can trust.  I haven’t a clue how the computer I am typing on at this moment works but I know that somewhere there is someone who does and what’s more could explain how and demonstrate it to me (and hopefully ignore my vacant look and silly questions).

Similarly in medicine, both human and veterinary, advancing technology means that today we are able to do things which, only 20 years ago would have been prohibitively expensive or dangerous if not downright impossible.

It behoves us though to be honest with ourselves about this technology from which we all benefit.  There is no place for head in the sand denial.  Problems such as side effects won’t go away if ignored; these inevitable if uncomfortable facts need to be recognised and dealt with in a mature and realistic way.  In short we need to admit that some breaking of eggs will be required when making omelettes.  Flat denial is of little consolation to Humpty Dumpty as you approach casually, whisk in hand, mouthing platitudes about the nutritional benefits of your finest cherry tomato and mozzarella frittata.  Humpty Dumpty would in fact be very well advised to run a mile from such advice.  Similarly we should all be extremely suspicious of anyone promising us something for nothing in any area, particularly medicine.  If something sounds too good to be true, whether it’s a “Humpty-friendly” omelette or a side effect free miracle cure, it probably is.  You don't get something for nothing in this life, particularly in the world of medicine and anyone who tries to convince you otherwise is at best labouring under a delusion and at worst, lying.

There is nothing more important than honesty when it comes to making health decisions for those family members who show us unconditional trust and who know we will act on their behalf and do what is best for them; our pets.  It is they who make being a pet “owner” such a special and difficult privilege and it is to them, for their trust and loyalty, that these writings are dedicated.