Editor’s Note–
Below, a post by Dr. Clifton Meador, author of more than a dozen insightful, often witty books including Sketches of a Small Town, Circa 1940 and True Medical Detective Stories. (When reviewing Sketches on Amazon, I compared Meador to Mark Twain.)
In the post below, Meador refers to one of his best-known stories, a tale set in the not too distant future titled “The Last Well Person.” The fiction, which was published as an “Occasional Note” in NEJM in 1994, uses satire to comment on the folly of our obsessive drive to test and screen every well person in America–until we find something wrong with each and every one of them. That “Note” ultimately inspired Dr. Nortin Hadler to write a book that would help many begin to understand what is wrong with American healthcare: The Last Well Person: How to Stay Well Despite the Health Care System. (2007)
This is not the first time that Clifton Meador has published on HealthBeat. Some of his most popular posts include:
–“The Mind-Body Connection: Could Psycho Somatic Conditions Account for 30% of Chronic Conditions?
— “How Medicine Became a Growth Business;”
Today, Meador is a professor of clinical medicine at Vanderbilt. The essay below originally appeared on The Pharos of Alpha Omega Alpha Honor Society, November 2011, and was recently cross-posted on The Health Care Blog (THCB)
M. M
Clinical Man
by Clifton Meador
In 1994, I recorded a fictitious interview with the person whom I imagined to be the last well person on earth. I mistakenly thought well people were disappearing and I wanted to call attention to their disappearance. I missed the big picture and now want to correct my misconceptions. Well people are not disappearing; instead, a new species of man is emerging: homo clinicus.
An evolution of the symbiotic relationship between man and medicine has been going on for some time. Lewis Thomas deserves the credit for an early spotting of the new species, first observed in America. He called our attention to this phenomenon in the 1970s.
Nothing has changed so much in the health-care system over the past 25 years as the public’s perception of its own health. The change amounts to a loss of confidence in the human form. The general belief these days seems to be that the body is fundamentally flawed, subject to disintegration at any moment, always on the verge of mortal disease, always in need of continual monitoring and support by health-care professionals. This is a new phenomenon in our society.
There has been a progression of terms for this new species. First, there was the “early sick” then “the worried well.” That was followed by “the worried sick.” We now have arrived at a definable new species that differs from pre-clinical man.
Pre-clinical man lived largely with medicine out of his consciousness. In fact he lived to avoid medicine. Those of us who are still pre-clinical will recall the earlier saying, “An apple a day keeps the doctor away.” That is almost pure pre-clinical thinking. Pre-clinical man only went to the doctor when he was sick or injured. It was up to pre-clinical man to decide if he was sick or well. It did not take a physician to make that decision. If he felt all right he was well; if he felt sick he was sick. Not so with clinical man. Feelings are no longer a reliable guide to health. Feeling good is not enough. There must be objective data that nothing is wrong. That’s the problem. Something is always wrong if you look long and hard enough at or inside any human. As a medical resident told a colleague, “A well person is someone who has not been worked up. We can always find something wrong, if we look hard enough.”