An Angry Electorate

One year from today (Jan. 20) will be Inauguration Day for a new President of the United States.  It is a topic of a lot of conversations.  

It also makes a great memory screening tool.  

I will sometimes start a conversation with a patient about news, politics or sports to gain an insight into their short term memory and thinking processes.  Short term memory loss can give an insight into cognitive function and be a early warning sign of dementia.  

I never ask how a person votes or will vote, simply what they think about current politics.  

That is usually enough for a conversation.  This year, it has been more than enough.  

I’ve read several op-eds from the typing-talkers and watched talking-typers on TV trying to describe what is going on in politics.  “The middle class has less money” or “the working class has less mobility” are some of their comments derived from reading impersonal polls while sitting at their desks usually in a large city with other political commentators sitting at their desks reading the same polls in the same large cities.   

If they could hear some of the comments I am hearing from patients, they would be a lot more concerned.  There is an anger and disgust in the words I am hearing that I have never heard before.  

All age groups.  All socioeconomic groups.  Republicans, Democrats and Independents.  There are common themes, though.  

Teachers just want to teach. Nurses just want to nurse.  Bankers just want to bank.  Law enforcement just wants to enforce the law.  Doctors want to doctor.  Business owners just want to run their businesses.  Retirees don’t want to live in fear. 

The vast majority are weary of the government and politicians interfering with their lives. 

Every group, excluding the retirees, feels like they have become data collectors for number crunchers sitting behind a desk miles away who takes the data and analyzes their success and value as a person and professional.  It seems almost everything is now tracked, analyzed and measured for someone else to look at and study.  

And who is that “somebody”? They are always right because they have the data to “back it up.” 

It is as if we spend more time gathering information than we do working for a better nation. 

It is Data Taxation without Data Representation. 

A perfect example of this is the announcement this week by Andy Slavitt, the administrator of the Centers for Medicare & Medicaid Services (CMS) that the data collection by physicians for “meaningful use” with electronic medical records will be changed because it is too burdensome. 

Specifically, he said "We have to get the hearts and minds of the physicians back," he said. "I think we lost them."  Well, bless his heart.  

There is also fear.  Real fear.  Retirees are fearful for their hard earned financial security.  Many are fearful for public safety. I know of several females who purchased their first firearm (pink handles for a few). 

There is anger.  Anger that the military’s sacrifice over the past 15 years seems to have been a forgotten, forlorn effort and even called unnecessary by some in government.   

Tell that to the families who lost their soldier, their marriage to a deployment, or to the one who wakes every day with a permanent scar. 

There is anger at the feeling of voting for a candidate  who will then only listen to someone with a lot more money than the average American.  It is a sense of voting for a politician who is owned by someone else.   

This is a very hostile electorate.  My goal has been to get a sense of a patient’s comprehension of current events and how they think about it.  I have gotten an earful.  

Clearly much greater than any election cycle I have gone through.  Clearly every political group.  

It reminds me of several movies where the star is trying to live a quiet peaceful life and then through a series of events unleashes the indignant, destructive beast within in a fury of retribution and justice.  Think Mel Gibson in “The Patriot” or Liam Neeson in “Taken.” 

Most people want to live a peaceful, fulfilling existence of personal production and providing for their family.  It seems like it has become personal, now. 

The politicians, candidates, political think-tankers, impersonal pollsters and nerdy news know-it-alls who keep people up late at night arguing opinions on cable news networks need to wake up and smell the diesel of the truck that is about to run over them.  

I am simply trying to determine the level of cognitive function.  I have learned a lot more.  

It was summed up by patient whom I know is already seeing his cognitive function slip a little.  When I asked for the name of a any well known candidate, he said “You know, the guy with the hair!” as he was laying his right hand over his head waving his fingers like hair in the breeze.  

He went on.  “Trump! Yeah, that’s him! That’s his name.  I don’t like him and ain’t goin’ to vote for him, but he shore’ is giving the Republicans a good education!”  

Eric J. Littleton, M.D. (@DrEricLittleton) is a Family Physician in Sevierville, TN.  His office is in the UT Regional Health Center Sevierville at 1130 Middle Creek Road. Topics covered are general in nature and should not be used to change medical treatments and/or plans without first discussing with your physician. Send questions to askdrlittleton@gmail.com

Re-Visiting Lung Cancer Screening

It’s political season.  The game of watching politicians perform backflips and pirouettes on a topic contradicting a previous statement now preserved forever on YouTube can be entertaining.  

Some people just can’t make up their mind. 

And so it is really confusing when it is a group of medical professionals changing a recommendation that seemed to be rationally thought out before.  We, the primary care physicians on the front lines of medical care, then try to explain why the recommendations pivot, turn, spin, wobble and then point like a child’s toy.  Evidence based data, of course. 

It almost seems to be like a big game of Twister trying to keep up with the changes in recommendations and then then challenges of implementing them in real practice.  

So it is with CT scan screening for lung cancer.  

Back in the fall of 2013 the editor of my local paper, Jason Davis, and I had a spirited debate and negotiation concerning me writing a column for The Mountain Press.  This legal and contractual drama took place on the football sidelines of Sevier County prior to a ballgame, lasted about two minutes and was interspersed with much more interesting details of a camera Mr. Davis was considering.  

The basic agreement was I would write a column twice monthly on medical information and topics related the current practice of medicine.  If he liked it, great.  If he didn’t, no big deal.  I have written on a lot of topics over the past thirty years just to clear my own thoughts on a matter with no intention of publication.  

I have loved reading newspapers since my third grade teacher brought them into class on Fridays.  Writers such as Sam Venable, Mike Royko, Carson Brewer, Jack Anderson, Peggy Noonan, Lewis Grizzard, Berkeley Breathed (Bloom County) and, yes, Charles Schulz (Breathed and Schulz with the gifted art of brevity and humor) have been some of my favorites. A newspaper and a sandwich is a great lunch for me.  

Surely I could write about medical topics and be accurate.  As accurate as one can be while driving on shifting sand, it appears.  

My first column attempted to explain why CT scans of the chest are not used to screen for lung cancer.  I tried to explain that it isn’t just about screening and that it has to do with false findings, unnecessary biopsies of those without cancer, worry over waiting on the next scan, radiation exposure and how it all would be paid for.  

Well, nevermind.  That’s all changed now.  

The U.S. Preventive Services Task Force (USPSTF) is the group responsible for evaluating current data and making recommendations to Congress and the public at large on preventive medicine.  They are “made up of 16 volunteer members who are nationally recognized experts in prevention, evidence-based medicine, and primary care. Their fields of practice and expertise include behavioral health, family medicine, geriatrics, internal medicine, pediatrics, obstetrics and gynecology, and nursing.”

Soon after my first column, the recommendation on lung cancer screening changed.  This was based on the National Lung Screening Trial of more than 50,000 patients.  Other organizations (including the American Academy of Family Physicians) disagreed with this citing the very same data did not clearly show that the benefits of a cancer diagnosis outweighed the risks of a lot of false positives (some say nearly 25%) and the additional cost.  

Oh, yes, the cost.  Who is going to pay for this?  Well, as of mid-2015 and after a lot of discussion, Medicare is for its members. Private insurance is unclear at this time. There is still a brisk discussion about the profits this will bring in for those providing this service. 

The formal recommendation states: “The USPSTF recommends annual screening for lung cancer with low-dose computed tomography (LDCT) in persons age 55 through 80 years with a 30 pack year history of smoking who are currently smoking or have quit within the past 15 years. Screening should be discontinued once the individual has not smoked for 15 years or develops a health problem significantly limiting either life expectancy or ability or willingness to undergo curative lung surgery.”

If a person strictly meets the criteria above, they should then consider having a discussion with their physician about this screening.  There are risks associated with this, up to and including complications of biopsying lumps that are not cancerous.  

And, to put it bluntly, if a person is truly worried about lung cancer, my first question is “are you worried enough to stop smoking?”  It is a solid point that should be seriously considered. 

“Data changes,” said a very well respected Family Physician lecturer during a national presentation this past year.  

The USPSTF is a group of highly intelligent a dedicated medical professionals with the best intentions in mind for the well being of this country.  Nevertheless, not all things that are important can be calculated and not all calculations are important. Dissecting that reality is the true challenge. 

Therefore, back to the basics.  Talk to your physician if you meet the criteria and decide if you want to have the screening done.  Some will. Some won’t.  Institutionalized single payer medical care with decisions made by one group for all of us is coming, in my opinion.  This is a brilliant example of how confusing it will be.