Over the past few years, I’ve been taking a hard look at mass screening programs.  Educational surveys showed that almost 40% of participants believed screening to be preventive in that they would actually prevent prostate cancer – that they could stop it from happening, like a vaccine – by screening.  Over 85% believed abnormal screening results to be a definitive cancer diagnosis.  This, coupled with overtreatment of men with the resources to pay for care – many of whom take advantage of 3-5 free screening events per year on top of the screening they receive from their primary care MD, and the apparent disinterest in caring for underserved men picked up at a mass screening “event” compound my unsettling feeling about these nobly rooted efforts.

In sharing these concerns with a good friend, the issue of screening underserved men came to a head for me as I realized how few of those of us who are comparatively privileged understand life of destitute and homeless persons.  The comment that resonates with me is “even if they receive no treatment, they get more from these events than they are you used to – someone is touching them.”  Anyone who believes that it is extraordinary for a homeless man to have a needle placed in his arm, or to have his intimate body parts invasively “examined” is just a tad delusional… If that is in fact our intention, why don’t we sponsor chair massages for these guys?  Isn’t that a whole lot less weird than screening them without treating any disease that is found – and if treatment is provided, leaving them to figure out how to manage the side-effects associated with treatment all on his own with no resources?

Where is compassion and empathy in all of this?  We really need to back up and advocate for education and holistic care for those with limited resources…

Earlier this year my mom was in a terrible care accident. She miraculously survived with multiple fractures. Were this to have happened to most women her age they would have been a pile of bone dust.

In the hospital after the accident they set what bones they could and attached an external fixater on her leg. The staff at the hospital said that in a few weeks they would remove the fixator and surgically install a plate in that leg. The hospital experience was terrible and dangerous. I had to constantly monitor staff to assure they didn’t give my diabetic mom and IV drip with sucrose in it – which happened no less than three times. After a few days my mom was moved to a rehab facility. In transition, the hospital forgot to write a prescription for blood thinners (a standard of care for bed ridden patients) and mistakenly documented her status as weight bearing. She couldn’t even sit up or role over.

About ten days later my mother’s legs were filled with clots. This is extremely dangerous. If a clot breaks free it can cause a stroke or a heart attack. So they dosed her up with a lot of blood thinners, I prayed and made sure the staff at the facility would watch her like a hawk anytime I couldn’t be there.

So the day arrived for the appointment when she was to have the plate placed in her leg. My brother was here visiting from Indonesia, so he rode with my mom in the ambulance while I drove so I would be able to pick my son up from school after the appointment.  When the young physician entered the room and asked how we were doing my mother said “great all things considered, just here to get the plate put in.” He asked “are you having problems with the fixator?” We responded by letting him know that this is just we had been told in the hospital. My brother and mother immediately began rationalizing how and why a plate would be better. It might “strengthen and fortify the bone.” The doctor responded with a hedging “I don’t know, maybe, but if that is what you want to do, we can schedule your for surgery.”

Because of what I do (advocate for cancer patients), I’m very sensitive to how dangerous and destructive making “more is better” blanket assumptions can be in respect to healthcare, and especially in situations that might feel acute.  So I say, “wait a minute, let’s really think about this. You will have to stop taking blood thinners prior to surgery – and your clots have just cleared up, spend another night in the hospital and we know that can be dangerous, undergo anesthesia, also dangerous, and sustain injury – because there is injury imposed during surgery, and this will inevitably prolong your healing. So if there is not in fact a benefit to having this done, I don’t think you should do it.”

The doctor excused himself for about five minutes returning with a recommendation against surgery due to my mother’s status as having diabetes, high blood pressure, and having been a smoker until just prior to the accident.

A few weeks later at her next follow-up appointment my mother was complaining about the fixator and lamenting that she hadn’t opted for the plate. On this day we were seeing a very seasoned doctor with much more experience than the last. He informed us that removing the fixator was the absolute worst thing that could’ve been done. The bone had broken clean at the top and the bottom of her shin, and shattered like a windshield in between the two breaks. By some miracle no bone had separated from the shattered break, and to open up her leg and start playing around with that might have left her crippled and in even more pain than she will be in for the rest of her life.

The lesson – ask questions and be educated and informed. Doctors hedge at a patient directing his or her own care as they fear litigation if they say no over what on the surface may appear to be choice. All too often they are only enabling a fearful reaction to a situation that the average lay person is just not used to.

This comedy of errors I think is more illustrative of healthcare today than most of us would like to believe. Overtreatment and inappropriate treatment is probably epidemic in respect to a lot of health related situations. However, undertreatment too can be a problem. We have got to be able to trust our doctors to weigh the long-term data and marry that with their clinical expertise while we strive to be informed educated advocates for our own care. If we fail to do so, the results could be catastrophic.

Those are the words of Warren Buffet, and from what has been published about his prostate cancer, he might be in a better seat if he was in one of those dry spells re ideas about treatment… and I keep pulling my hair out wondering what national advocacy groups are doing. Will they rise to the challenge and approach Mr. Buffet with an incredible opportunity… learn more about his disease before subjecting himself to side-effects and the possibility of life-shortening treatment toxicity?  Or raise his level of decision making awareness to the point that he might educate other men who are diagnosed as well as he does investors?  I mean, it would be a real shame if the only thing anybody asked him for was money and to talk about screening and how happy he is that he (perhaps) underwent a treatment he did not need…

“Economic medicine that was previously meted out by the cupful has recently been dispensed by the barrel. These once unthinkable dosages will almost certainly bring on unwelcome after-effects. Their precise nature is anyone’s guess, though one likely consequence is an onslaught of inflation.”

-Warren Buffet

Just reflecting on an incident last year. I was out for a jog in my neighborhood, I saw a young family out for a walk… always a wonderful thing to see. The young daughter got something in her eye and began to cry. Both parents immediately rushed to her, letting go of the baby stroller the mother was pushing. As they huddled around their daughter – the baby stroller slowly gained momentum down a hill towards an intersection. My own instinct caused me to pick up pace to a panicked run as I crossed the street to keep the carriage from rolling into the road… with no idea of its contents. Meanwhile a man in a car and a lady walking her dog complacently watched. As I caught the carriage just before it rolled off of the sidewalk and into the street – yes, a baby was in the carriage… I ran the carriage back to the parents who numbly thanked me. About 5 minutes later the dad pulled up to me in a car and thanked me for “saving” their baby. A few days later the dog walking lady commented that there must have been some story in my life that had something to do with the baby carriage incident. The truth is – NO – there is no trauma in my life that caused me to behave like a concerned and caring human being. My maternal instincts caused me to care whether or not a child that may be within that carriage ended up as road pizza. Lesson being people in general need to wake up…. we are intrinsically connected and each and every one of us every now and then has the opportunity to make a difference. So if you aren’t already awake like that – now more than ever, we need to WAKE UP.

What happened yesterday in NC (passing of NC Amendment 1) is shameful beyond reason. If you claim to be an advocate for men’s health and you do not advocate for veterans or if you support anti LGBT legislation you are NOT an advocate for men’s health – period.