Working with Rare Illnesses

The emphasis on working with rare illnesses also creates problems. Most important, this emphasis (along with the emphasis on intervention) has contributed to the oversupply of specialists and undersupply of primary care doctors in the United States. Some two-thirds of U.S. doctors are spe- cialists, although most patients require only primary care. Similarly, emphasizing acute illness leads doctors to consider patients with chronic illnesses uninteresting and makes, for example, orthopedic surgery a more appealing field to new doctors than rheumatology (the nonsurgical care of arthritis and related disorders).

Other problems stem from medicine’s mechanistic model of the body. This model leads doctors to rely on reductionistic treatment, or treatment in which doctors consider each body part separately from the others—reducing the prob- lem to one part—in much the way auto mechanics might replace an inefficient air filter without checking whether the faulty air filter was caused by problems in the car’s fuel system. In contrast, sociologists (as well as a minority of doctors) argue for a more holistic image of how the body works and of how illness should be treated. Holistic treatment refers to treatment that assumes all aspects of an individual’s life and body are interconnected. For example, rather than per- forming wrist surgery on typists who have carpal tunnel syndrome, it might be better to recommend using a wrist rest while typing or changing the height of the typist’s desk. And rather than simply excising a tumor when someone has cancer, perhaps doctors and other health care workers should also explore how their pa- tients’ social and environmental circumstances contributed to cancer growth and how psychological and financial support might improve their odds of recovery.

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Finally, emphasizing intervention can foster overtreatment by encouraging medical students to enter the most interventionist specialties and encouraging doc- tors to use the most interventionistic tools even when more conservative approaches might better serve patients’ interests. For example, research suggests that back pain can best be treated by improving the ergonomics of individuals’ work environments rather than by injecting potentially dangerous steroids into patients’ spinal columns, yet doctors more commonly suggest the latter rather than the former.