Medical Side-Effects

My aunt died 12 days ago. I don’t want to write about my personal feelings about this, but I do want to write something about the events that led to her death. I don’t know all the details, but this is the basic story I heard as it evolved. Two or three years ago, at the age of 60, my aunt had a chest X-ray for some reason. She was in reasonably good health, but this X-ray picked up an unexpected growth of some sort. The doctor recommended that they wait six months and take another look. After six months, they looked again, and the growth was still there, and, though it was hard to be certain, it might have gotten slightly larger. The doctors started discussing the possibility of doing a biopsy to see if it was cancerous. My aunt was understandably alarmed about all this, and on the advice of a doctor agreed to go ahead with the biopsy.

I don’t know exactly where the growth was, but the operation for the biopsy was major. They had to left up the rib cage and make a major incision in the chest. I spoke to her just after the operation and she was still grappling mentally with how major it was, how weak she felt, and what her projected recovery was going to be like. As it happened, she never truly recovered. While she did leave the hospital for a time, she had a series of increasingly serious infections due to the side-effects from the operation, and spent more and more time at the hospital. After a couple of years of this, she died from one of the infections. The biopsy showed that the growth was benign, and she would have been fine if nothing had been done.

This all happened in the U.S., where medicine has a strong bias toward doing something rather than nothing. Doctors get paid when something is done, not when nothing is done. I believe that U.S. culture in general is biased toward taking action rather than waiting. It would be unfair of me to blame this entirely on the medical system. Once the growth was detected, my aunt would have worried about it if nothing had been done. But I don’t think she truly understood what she was getting into with the operation even if all had gone well.

In the end, she died at the age of 62. The cause of death was the modern medical system. Perhaps she would have done better if she had felt differently about the information, or if she had gotten different advice, or if she had lived in a different country. We’ll never really know. But it’s certainly hard to feel comfortable about what actually happened.

4 Comments »

  1. fche said,

    August 26, 2010 @ 7:50 am

    It is a tragic illustration of reasoning based on incomplete and uncertain information. And yet, such knowledge is a fact of life in almost every area. At least, here, individuals are empowered to make their own guesses and take their chances: they own their own lives. In a place where an individual is routinely overruled by People Who Know Better, they would lose some humanity.

  2. Ian Lance Taylor said,

    August 27, 2010 @ 6:17 am

    I agree that people should always be free to make their own choices. Everybody does have that choice in any case, at least everybody wealthy enough to fly to India.

    My concern is more that she got what turned out to be bad advice, and everybody giving that advice had a financial incentive to provide exactly the advice that they gave. In fact, due to her long hospital stays, her doctors and her hospital wound up earning hundreds of thousands, perhaps over a million, dollars, paid by the insurance company. We rightly do not give the insurance company a role in giving medical advice, because they have a financial incentive in telling us to stay home. But in the U.S. fee-for-service system, doctors have a financial incentive in telling us to get services.

    When our lives are at stake, we do not react rationally. I don’t think it’s sufficient to say that we can look up information on the Internet when we are not ourselves medical professionals and are unable to judge medical conditions. We need good advice at those times. It’s very possible, even likely, that my aunt did get good advice. But it’s troubling that the people giving her advice, however disinterested they tried to be, had a financial incentive.

  3. fche said,

    August 27, 2010 @ 6:54 am

    “But it’s troubling that the people giving her advice, however disinterested they tried to be, had a financial incentive.”

    That’s an excellent point. Hidden or unintended incentives in any social system can serve to corrupt it. I don’t know of any solution better than aggressive disclosure, where self-recusal is not possible. In some other industries, one can put advisors on salary, who would not have to be in conflict of interest.

  4. Joel Brobecker said,

    September 2, 2010 @ 10:58 am

    I recommend reading the book “How we die”, by Sherwin B. Nuland. Beyond the clinical description of the major causes of death, there is also a reflection on the side-effects of treatments and whether sometimes the cure is worse than the illness. I think that it gets us better prepared for these difficult moments in our life where we have to make these kinds of decision. And it also shows that, if not all, some doctors are aware that staying alive at all costs is not necessarily the right strategy.

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