I Am Not an InstaDoc*; This Is Not InstaMedicine*

* (I know these words are used for Instagram pictures of beautiful medical professionals and gory surgical procedures, but I choose to use them as words of instancy in the practice of medicine.)

The other day a patient called every hour to inquire about the status of her elective cardiology referral. She had been thoroughly evaluated twice at the hospital for chest pain and wanted a consultation.

Another patient called three times the same day because she had seen “Ambulance Chaser” legal firm advertisements about lawsuits against manufacturers of generic valsartan, which may have traces of Chinese cancer causing chemicals.

It has been said that new medical information takes 17 years to alter the way we practice medicine. Contrast that with the immediacy of today’s electronic media…

A certain delay before acting is not a terrible thing in every instance. Overcorrection can be just as risky as undercorrection when you’re steering a big ocean liner approaching a harbor or a fast moving car on icy Maine winter roads. Or when you’re juggling the multifaceted responsibilities of caring for hundreds of patients’ lives.

We live an era of instant fulfillment. We have become impulsive and impatient. Fewer and fewer things are considered better when taking the time they used to take: Faster is viewed as inherently better.

Speed reading and speed dating, same day surgery, curing lifelong depression with a single infusion – we strive to defeat time and the forces of nature. There is no respect for the rhythms of life.

And yet, there is also the mindfulness movement, but it is largely linked to the alternative practices of medicine. Mainstream medicine is paying some lip service to such things, but it is becoming more and more firmly pigeonholed in the whirlwind of consumerism and electronic immediacy.

The practice of medicine used to be, and should return to being, a more contemplative pursuit. When we constantly go for the quick fixes, we risk overlooking or not even understanding the big picture.

In the case of the drug recalls, it wasn’t too long ago that some of my patients insisted on being switched from one angiotensin receptor blocker to another and then another and then yet another as the news about their impurities trickled in.

And, remember Vioxx, Merck’s stomach-friendly arthritis pill? Sales were booming, then reports of high blood pressure and heart attacks started to make the news. Merck panicked and took the drug off the market. Pfizer had steadier nerves and kept making their sister drug, Celebrex. Not long after, the data came out that Celebrex also increased heart attack risk, so doctors started to avoid it and switched patients back to the older NSAIDs. However, they, too, turned out to increase heart attack risk. Not as much, but still enough to make us reconsider our use of all of them.

In this case, instead of panicking and switching patients back and forth in desperation, we would have been better off doing nothing while stepping back and assessing the situation.

We’re supposed to be professionals, not robots…

2 Responses to “I Am Not an InstaDoc*; This Is Not InstaMedicine*”

  1. 1 Ralph k Allen April 15, 2019 at 8:19 am

    Thank you for stating the simple truth of the matter in a clear and viable way. I am 76 y,o. and still practicing administration in health care facilities. Instant response is often hazardous to the health of institutions as well as human beings. Pausing to think before acting is good medicine for us all.

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Osler said “Listen to your patient, he is telling you the diagnosis”. Duvefelt says “Listen to your patient, he is telling you what kind of doctor he needs you to be”.



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