Pills vs. Time: The Power of Patience

Another interesting article about slowing down our rush-to-treatment healthcare mentality (see Pills & Perils below) appeared in Tuesday’s ‘Personal Journal’ section of The Wall Street Journal. This one is a lot simpler: do nothing, just wait. WSJ‘s Melinda Beck is writing less about serious afflictions than about the minor problems that plague us all; still it points once again to our cultural tendency to Do Something, whatever it is.

What cures colds, flu, sore throats, sore muscles, headaches, stomach aches, diarrhea, menstrual cramps, hangovers, back pain, jaw pain, tennis elbow, blisters, acne and colic, costs nothing, has no weird side effects and doesn’t require a prescription?

Plain old-fashioned time. But it’s often the hardest medicine for patients to take.

“Most people’s bodies and immune systems are wonderful in terms of handling things—if people can be patient,” says Ted Epperly, a family physician in Boise, Idaho, and president of the American Academy of Family Physicians.

“I have a mantra: You can do more for yourself than I can do for you,” says Raymond Scalettar, a Washington, D.C., rheumatologist and former chairman of the American Medical Association. But, he says, “some patients are very medicine-oriented, and when you tell them they aren’t good candidates for a drug they’ve heard about on TV, they don’t come back. I have colleagues who say, ‘You can take this pill and get better in two days, or do nothing and get over it in 48 hours,’ ” says Dr. Scalettar.

Of course, we know this. Most of us have some genetic strain of either the leave-it-alone-it’ll-be-better-in-the-morning or the shut-up-and-tough-it-out approach to all aches and pains. But we also have those constant messages from the TV set, and increasingly from the computer screen, that say one little pill will make it all better, right this very minute. And we are a right-this-very-minute society.

Almost all viral infections resolve on their own, unless you have a compromised immune system. As a rule of thumb, Dr. Epperly says, infections in the nose, throat, stomach and upper respiratory tract tend to be viral. Infections elsewhere in the body are likely to be caused by bacteria, and those can get worse without antibiotics. About 80% of urinary-tract infections resolve on their own, for example, but about 20% develop into more serious kidney or blood infections. And even if they don’t, the symptoms can be very uncomfortable.

Some chronic maladies follow predictable courses, according to many medical experts ,whether or not they are treated.

Colic is almost always gone in four months. Some 70% of acne is gone three to four years after it first appears. “Frozen shoulder”—a painful restriction of the shoulder joint—is typically painful for three to six months and stiff for the next four to six months, and resolves completely after one to three more months. Temporomandibular joint (TMJ) pain tends to go away by itself in 18 months. Sciatica resolves on its own in three weeks in 75% of cases.

Not many of us do pain and misery very well. As a repeat TMJ sufferer, I can promise you if I tried to wait it out without pain killers for 18 days, let alone months, my entire neighborhood block would evacuate. Pain (see Caitlin Kelly’s Broadside post a few hours ago) is in a category all its own. Actually, though it is hell to pay, sometimes it can serve a purpose. My good husband wound up in the emergency room with a gall bladder infection that would’ve had anyone else, surely including myself, shrieking in agony; he does not feel pain. That is great when you’re young and macho, not so good when you get a few years on you and could use a signal that something’s wrong.

But for the minor issues, things wrong can often right themselves without outside interference. Now… if I could only start over again with everything I should or shouldn’t have taken…

When Doing Nothing Is the Best Medicine – WSJ.com.

4 responses

  1. I read that piece and found it fascinating, because our responses to pain – and demands for action/solutions NOW — is indeed culturally biased. Americans expect solutions while those in other cultures may not have the money or access to those solutions and are expected to deal, whether that means waiting, being patient, using fewer drugs.

    I have always been scared of getting addicted to any sort of painkiller so generally have not taken many, even when in terrible pain from orthopedic injuries/surgeries/PT. It takes a lot to get me to swallow a fistful of Advil. I know many-to-most things are self-limiting (including life!), and try to calibrate when or if to pay attention to a pain and see a physician. If I had been more attentive to my body when I had a cold that worsened (instead of toughing it out), I could have avoided getting pneumonia and its agony.

    For some people, pain is something to vanquish at every opportunity, for others something (not like TMJ Pain) to ignore as best they can.

    • Knowing when to tough it out or not is the big question. I once sent my son off to elementary school with a little cold cream on his tummy saying, “This’ll fix that rash I’m sure” only to have the principal call and say, “Fran, dear, he has chicken pox.” Who knew. If there’s a guideline at all I suspect it is to address real pain like our friend Brian’s every possible way, but to use extreme caution with all drugs. Side-effect small print is full of so many horrors as to require tranquilizers just to read it clear through.

  2. Would that only more physicians had that point of view! I had what turned out to be musculoskeletal problem, but it was in a place that sent thrills up and down the spines of the gastrointestinal crowd. About $20K out of pocket later (I’ve changed my health insurance after that), well I knew that all I had to do was exercise more and learn to live with it. I now mark it up to being old but sometimes just sometimes I sure do wish there was a nonaddictive non-organ-threatening no-side-effects-whatsoever pill.

    • Uh oh. I have an appt with physical therapist for musculoskeletal issue I self-diagnosed as tensor fasciae something or other. My primary care doc e-mailed that my diagnosis seems correct (I do love the Kaiser e-mail-your-doctor program) so we’ll see what Susan the PT says. Haven’t taken a pain pill yet, but it’s been messing up my exercise plans. I’m counting on PT to show me some alternative exercise plans. Glad you got your insurance changed, at least. I still hope & pray for options (public, please) remain in reform bills.

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