The U.S. healthcare system is a bit strange compared to the rest of the world. In almost every aspect, our focus is on direct treatment. While one can argue that this is a result of economic or legal incentives and the free market innovation, ultimately, I think it is about cultural attitude. Americans value choice, above all—the freedom to make their own decisions about what happens to them.
What this results in is the lack of preventive medicine, to the detriment of the population at large. Fewer and fewer physicians are going into primary care, instead choosing to pursue more lucrative specialties—and who can blame them? That’s what society seems to want.
A story I read in the New York Times illustrates the differences in perception:
I recently had a hysterectomy here in Munich, where we moved from California four years ago for my husband’s job. [. . .]
I brought up the subject of painkillers with my gynecologist weeks before my surgery. She said that I would be given ibuprofen. “Is that it?” I asked. “That’s what I take if I have a headache. The removal of an organ certainly deserves more.”
“That’s all you will need,” she said, with the body confidence that comes from a lifetime of skiing in crisp, Alpine air.
I decided to pursue the topic with the surgeon.
He said the same thing. He was sure that the removal of my uterus would not require narcotics afterward. I didn’t want him to think I was a drug addict, but I wanted a prescription for something that would knock me out for the first few nights, and maybe half the day.
[. . .]
“. . . but I am concerned about pain management. I won’t be able to sleep. I know I can have ibuprofen, but can I have two or three pills with codeine for the first few nights? Let me remind you that I am getting an entire organ removed.”
The anesthesiologist explained that during surgery and recovery I would be given strong painkillers, but once I got home the pain would not require narcotics. To paraphrase him, he said: “Pain is a part of life. We cannot eliminate it nor do we want to. The pain will guide you. You will know when to rest more; you will know when you are healing. If I give you Vicodin, you will no longer feel the pain, yes, but you will no longer know what your body is telling you. You might overexert yourself because you are no longer feeling the pain signals. All you need is rest. And please be careful with ibuprofen. It’s not good for your kidneys. Only take it if you must. Your body will heal itself with rest.”
I didn’t mention that I use ibuprofen like candy. Why else do they come in such jumbo sizes at American warehouse stores? Instead, I thought about his poetic explanation of pain as my guide, although his mention of “just resting” was disturbing. What exactly is resting?
I know how to sleep but resting is an in-between space I do not inhabit. It’s like an ambiguous place that can be reached only by walking into a magic closet and emerging on the other side to find a dense forest and a talking lion, a lion who can guide me toward the owl who supplies the forest with pain pills.
[. . .]
Come to think of it, I bring a lot of medicine with me from the United States, all over the counter, all intended to take away discomfort. The German doctors were telling me that being uncomfortable is O.K.
[. . .]
After a week, I took the tram to the doctor’s office to have my stitches removed. My doctor, with her usual cup of chamomile tea in hand, remarked on my progress. “I rested,” I told her. Normally, I would have said, “I did nothing,” but I didn’t say that. I had been healing, and that’s something.
Firoozeh Dumas
Dossier
“After Surgery in Germany, I Wanted Vicodin, Not Herbal Tea,” by Firoozeh Dumas, January 27, 2018. https://www.nytimes.com/2018/01/27/opinion/sunday/surgery-germany-vicodin.html