아래글은 2년전 갑상선 암 치료에 대한 코리아 타임즈의 기사를 읽고 독자 투고한 글인데.. 일반적으로 중앙일간지는 이런 종류의 하품나는 글은 잘 안실어주는데... 영자신문이라 그런지 별 수정없이 실어주었다. 나중에 다시 한글로 바꾸기로 하고 우선 여기 올리기로..
Hippocratic advice: To do nothing can be good remedy
Hippocrates, the father of western
medicine, said “To do nothing can be a good remedy." Derived from these
instructions, “watchful waiting” is an approach to various medical problems
where time is allowed to pass before medical intervention or therapy is used.
During this time, close observation may be needed even though what most consider
as medical treatment — drug prescriptions, expensive tests such as blood tests
or x-rays, or surgical intervention — is not given to the patient. In medical
school, “watchful waiting” is taught as an important therapeutic
strategy.
Watchful waiting can be used for a very broad
range of medical problems, the most typical of which is the common cold. If a
patient presents a runny nose, mild cough and fever, he or she can be
recommended to rest, drink plenty of fluids and wait until the symptoms resolve
themselves. Not a single medical textbook supports doctors prescribing
antibiotics for a common cold. In addition, this strategy can be applied to many
typical medical conditions, such as gastritis and diarrhea, and abdominal,
joint, muscle, and back pain.
Surprisingly, even in a much
more serious ailment like cancer, such as early stage thyroid cancer or prostate
cancer in the elderly, the watchful waiting strategy compares favorably to
active anticancer therapies like chemotherapy, radiotherapy and surgery. For
example, elderly patients diagnosed with prostate cancer using PSA (prostate
specific antigen) testing are often better served by “watchful waiting” than by
aggressive treatment with radiation and surgery, which are likely to leave
patients with erectile dysfunction and/or urinary difficulties, not to mention
the money and worries which accompany anticancer
treatment.
Many elderly patients with early stage prostate
cancer never become symptomatic, and chemotherapy and surgical “cures” serve
only to diminish their quality of life. Some medical experts currently claim,
and have research to support their claims, that some types of cancer are over
diagnosed, leading to overtreatment. One study showed that one in three women
with breast cancer are over diagnosed and receive surgery and/or chemotherapy
which was unnecessary, not to mention potentially harmful.
I
am not saying that for all diseases and symptoms physicians should wait until a
patient’s condition becomes serious. On the contrary, every symptom and disease
should be considered serious until it is resolved completely. However, doctors
and patients must recognize and accept that as human beings, we will suffer from
minor aches and pains, most of which are very natural phenomena and thus
unavoidable.
Doctors and patients must also be actively
aware that no medicine or medical procedure, or even test, is free from side
effects, which while may usually be mild but sometimes turn out to be fatal.
Medical science has yet to discover a magic bullet without side effects, so
doctors must carefully weigh the benefits and the harm in every medical
intervention seriously.
Certainly, watchful waiting is not
an easy decision. In some ways it is the most difficult decision in medicine,
especially with a serious disease like cancer. It needs a clear understanding of
not only medical technology but also a holistic understanding of the patient’s
status, including physical and mental aspects.
In the real
world, the watchful waiting strategy is seldom used because it is very difficult
to apply. First of all, it is an uphill battle with patients, suffering from
pain or distress, who expect to be tested and treated, either with drugs or
surgery. Consequently, for physicians, it is a time consuming and challenging
task to persuade patients to accept “watchful waiting.” Doctors have an old
saying, “To write prescriptions is easy, but to come to an understanding with
patients is hard.”
Additionally, when doctors do not offer
treatment, they may lose their patients’ trust. Doctors may be considered lazy,
or may even be sued when the results are negative. Alternatively, patients may
seek a second opinion in hopes of finding some new medicine or high tech surgery
to eradicate their disease once and all. Such hopes are often highly
unrealistic.
Most of all, it’s about money. In Korea and
many other countries like the United States, and even in Europe with its
socialized medicine, doctors are paid by what they do, creating a “do more, bill
more” mindset. In capitalist society, even doctors, though they have jobs most
envy, are not free from money concerns.
Thus, from a common
sense point of view, it is better for doctors to offer some kind of treatment,
whether truly necessary or not, than to offer nothing. Moreover, in Korea,
doctors cannot bill for their services, no matter how much time they spend
examining and talking with a patient, if they do not write a prescription or
order some type of treatment, which is antithetical to good medical
practice.
It is not the high technology drugs or state of
the art expensive medical devices or high rise luxurious hospitals which save
people’s lives and relieve their suffering. Good medicine depends much more on
good communication between patients and doctors and their reasonable
decisions.
We need a medical system that fully supports
“watchful waiting,” that knows what any good mechanic knows: “If it ain’t broke,
don’t fix it.” However, such a sea change won’t happen overnight. Until then,
individuals, both doctors and patients, must take responsibility for medical
decisions that put the patient’s health first, even if that means doing
nothing.
