It's Procedures All the Way Down
Can we stop with the health "care" euphemisms?
Is there a rule of journalistic style dictating that the stuff that medical professionals do are treatments and procedures, unless they are controversial, at which point they become "care"? Most of the doctors that I've ever been to, even the deeply caring ones, perform examinations, diagnoses, treatments and procedures. I don't think I've ever been to a doctor who said, "Tom, I need to do some care here."
The orthopedist I saw for my shoulder a decade ago was oddly transparent about it. Figuring that he might appreciate a more complete, holistic description of how my issues unfolded, I told him that I thought an elbow problem led to my shoulder problem. He stopped me abruptly and responded, "Well, what do you want me to treat, your elbow or your shoulder?" He might as well have handed me a Chinese takeout menu with check boxes. Eventually, he put me to sleep and yanked my shoulder around to break up the scar tissue, for which I was grateful. It felt very much like a procedure -- I don't think he cared a whole lot, as I never went back or heard from him. Nor did I even talk to him before that procedure, except for a perfunctory “Hello, I’ll be back in a few minutes.” It was a procedure. A transaction.
That said, the physician’s assistant (PA) who works in the same practice is a really nice, personable fella, and I sense that he does care. Earlier in the shoulder saga, sensing the pain I was in, he sent me home with a prescription for some much-needed opioids, despite the growing stigma at the time. And when I returned to him a couple years ago with a Lyme-infected knee the size of a football, he remembered me and my shoulder, and took the time to chat a bit. And then he drained my knee. He drained it two more times that week. They were all procedures too. He's a super nice guy, but his job is to perform procedures. And he does them well.
And then of course there's the ERCP guy. That’s “Endoscopic Retrograde Cholangiopancreatography“ to the uninitiated — try to say that fast ten times in a row. Anyway, he did three of them on me and saved my life twice. He interrupted a vacation the second time. Now that guy cared. I need to track him down and send him a note. But ya know what? They were procedures. Really complicated, highly skilled procedures. He also did a high-tech CT scan with some sort of radioactive contrast. And literally the second he detected the bile leak that he knew had to be there, he yelled "There it is, Tom! We're done!" and whisked me out of the machine because he understood the pain I was in. A couple years later he did a colonoscopy -- low tech, by his standards -- after which he smiled widely and and pronounced me fit as a fiddle. The guy truly cared. But, ultimately, I'd be dead if it weren't for the procedures.
I deeply appreciate all the treatment I've received from a very caring PA and an even more caring gastroenterologist. Their procedures altered the trajectory of my life. In their cases, the "care" was a nice touch that was charming on a human level. But they don't really get paid to care, or to provide "care". The ortho clearly didn't care very much, which turned me off; he wasn’t very charming. But I greatly appreciated his yanking of my shoulder -- which, again, was a procedure.
You can call it health “care” all you want, as your agenda requires. And it seems to me that many journalists "want" quite a bit, when they are writing about sensitive, partisan issues, and need to describe this or that procedure as this or that "care", in service to an agenda. But in the end, the wisdom or legality of this or that treatment or procedure isn't about "care". It's about risk/benefit and cost. That sounds cold, but that's what modern western medicine is. And it can do great things, even if your ortho reduces your complex humanity to a shoulder joint to be yanked. You don't get to alter the cost and risk/benefit elements of the underlying reality by immersing the discussion in the soft floral notes of kind and gentle semantics. The reality will be what it is. And, with deepest apologies to the turtles, the universe of medicine that we inhabit is procedures all the way down.
Thanks for reading.
For more reflections about gardening and the broader life lessons it bestows on us, feel free to check out my online book, Life Lessons of a Backyard Gardener, which I am publishing here, one chapter at a time.