From the Desk of Dr Earp "Mac Donald Syndrome"- For your Health Series #1

Speeding To An Early Demise

Western societies place such a high premium on speed, multitasking, goal oriented living and accomplishments that we, as Americans, are incurring/suffering from an epidemic of anxiety, panic disorder and depression. Coupled with the national tendency to also suffer from denial we, as a culture, are experiencing increasing rates of occupational and professional burn-out. Ultimately, this will not only make us a more sickly populace but an ever dependent one. It will also harm and make inaccessible the works of great artists, musicians and geniuses who are born each generation but develop incapacitating mental illnesses or addictions causing same; they die before their artistic skills effloresce (or come in to their own). We are our own worst enemy.

Mark Twain, writing in The Keokuk Daily Post, November 29, 1856 astutely observed while riding on a train that the scenery, and hence by reference life, was moving way too fast (the actual speed was in the 40 mph range!). “I jest took a peep out of the winder, and drat my buttons, if I wasn’t astonished at the way that rail road was a gittin over the ground. I tell you, Mr. Editors, it made a rail fence look like a fine tooth comb, and the air actually turned blue in the vicinity. Thinks I if that devil at the other end of the train’s going home tonight, it won’t take him long to get there.” (Snodgrass; He couldn’t appreciate any of the visual rewards of travel; he could not see the terrain, the flora. It, to him, was a blur. He implied this did not bode well for our culture.

Practicing medicine, I witness Hurry Up or Mac Donald’s Syndrome borne out daily. While it is unfortunately an imbued characteristic of the majority of working and nonworking persons, I am most familiar with its manifestations in a medical setting.

Patients (and their families) incorrectly and incredulously think the delivery of medical care is analogous to procuring a hamburger. You simply arrive at the hospital, very ambiguously state your intent or wants, and the entire ER staff will jump right on that. I am not talking about true life-threatening emergencies which comprise a small proportion of the patients seen in an ER on any given day.

To worsen matters to a tremendous degree is the very common patient lack of any detailed knowledge concerning their medical/surgical history, the names and dosages of current medications and any recent medical treatments or hospitalizations. The majority of folks who have a primary care physician generally can’t tell you his/her name or practice name! Yet this information, along with allergies, can literally not only make a major impact on treatment decisions but may, by the patient’s own hand, cause themselves harm. It is the patient’s responsibility to provide an accurate and current medical history. Rare is the knowledgeable patient or one who at least maintains a database (such as writing on paper!) on their person with details of their medical history. Nearly all folks of middle age and beyond presenting for evaluation are on prescription medications and have one or more chronic illnesses. But when asked about this information they again become impatient demanding “a pill or shot so I can get out of here.” [sic]

Oftentimes, the patient and/or their family has an ulterior motive in their need for speed in the ER. Granny-dumping is an example. Bring Grandma to the ER under the premise she is acutely ill when in fact she is not; the family is either incapable or more often unwilling to devote the time and resources to care for their parent. It is a despicable scenario. The associated scenario is that of the elderly patient who was recently hospitalize; the physician strongly suggested skilled nursing care facility placement but the family refused, out of some ill-conceived and misinformed emotional notions of “never letting Momma go to a nursing home.” Well, sometimes things simply are as they are. The care required may be totally beyond what the family can provide and guess who suffers? Momma. So, she is brought to the ER, usually during the night or early morning hours, again under the guise of an acute illness but it ultimately comes out, “We just are at our ropes end. We can’t take it anymore. We want her admitted for three days and then moved to a nursing home.” This is such a common scenario. Even more heartbreaking are the times family members, having brought Momma to the ER, leave and never respond to phone calls and never return. Apparently they are too busy and in too much of a hurry to care for their parent.

Common presentations of the Mac Donald’s Syndrome involve a patient or entire family demanding rapid service because:

1. “I haven’t eaten all day and want food with a drink” (Whose fault is that?)

2. “I was sick yesterday and need a work excuse.” (From the ER?)

3. “I ran out of my medicines a couple of weeks ago.” (Hello!)

4. “I have an appointment with my doctor in 2 hours – I came here because I thought it would be faster.” (You obviously haven’t been here lately or read newspapers!)

5. “I need help with drugs.” (And how many years have you had this addiction? What is today’s emergency?)

6. “I need help with alcohol.” (How long have you been addicted and how many times have you enrolled in detox programs?)

7. “I want a pregnancy test.” (So the patient presents, without insurance or funds, with the complaint of a missed period and early morning nausea and vomiting. The patient can purchase an OTC pregnancy test just as accurate as the urine test used in the ED. However, they would be expected to PAY at the time of purchase in the store for the test. Now, without a thought for hospital, societal and resource cost they will incur charges exceeding $500.00 for something costing less than $10.00; their own fault)

8. “I ran out of my Lortab.” (Did you call your doctor? “No.”)

9. “I was in a car accident and now my neck, back etc. hurt and that guy is gonna pay.” (The patient then expects the hospital and physicians to wait for this presumed financial settlement believing [falsely] that they can put the charges on hold because something wasn’t their fault. They are asking for the service therefore they are responsible for the charges.)

10. “I’ve had [chest pain, a headache, abdominal pain, etc.] for a month or two.” (And what made today so special after waiting all this time?)

11. “I’ve got better things to do with my time than stand around in here and wait for you to treat my wife (or husband).” (Isn’t the health of your loved one paramount in importance; it must be, you brought them to the ER)

If the physician makes the mistake of trying to accommodate or feed into their demands of hurried evaluation and inappropriateness, some of these same people will, at some time in the future, file a malpractice suit against the physician and completely deny they demanded speedy service with its attendant risks. They and their lawyer will make a litany of false allegations and the hope for winning The Malpractice Lottery will go on for the 1-3 years it will take to process the claim. The plaintiffs lawyer may argue that the physician should have imposed his/her control of the patient evaluation. The Hospital Administration will not support the physician, although their unwritten policy, reiterated over and over, is to “move the meat” and “do whatever you can to make our Patient Satisfaction scores high – Just give the patient what they want.”) Although from a strictly business model patients are customers, the nature of diagnosing and treating diseases on individual human beings negates much of this analogy and does not make patient satisfaction scores comprehensively relevant.

Mac Donald’s Syndrome is a serious manifestation of the psychological and behavioral ills which have befallen the denizens of industrialized society. As a matter of fact, those societies, industrialized or not, who adopt our perspectives soon fall victim to this same phenomenon. As individuals and as a society it is imperative we look closely at our behaviors and what modifications are needed to maximize our mental health. Hurry Up Syndrome is merely a sign of the underlying severe anxiety and associated disorders which now afflict so many people. The human brain has not had time, in an evolutionary sense, to adapt and develop appropriate coping mechanisms for the immense profundity of attention required of it. The sheer number of persons requiring psychotherapy and/or anxiolytic medications is immense and growing. We set goals we cannot reasonably accomplish. We set time tables we cannot meet. We demand “multitasking” as a means of accomplishing more in shorter periods of time.

Yet we don’t take time out for ourselves nor our loved ones. By the time we retire our minds and bodies are literally exhausted. We may physically live longer but we do so sustaining more and more maladies, spending our retirements sitting in physician’s offices or lying in hospital beds!

Posted By Dr. Dennis to DocEarp’s Cyberspace href=’’ title=’the-man.jpg’>the-man.jpg

Don’t be afraid he is part human.

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