Awaiting Diagnosis
by Charles Ford, M.D., Board of Directors member

Stephen Karam’s play Sons of the Prophet is provocative, revealing, and particularly disturbing to me --a health care provider and concerned citizen. The action reveals a perfect storm in which the common denominator is sickness and related vulnerabilities. His father dies and elder son Joseph must assume unanticipated responsibilities as he struggles with a cascade of stressful events including caring for his progressively disabled uncle and attempting to deal with his own undiagnosed illness: He was an elite runner, burdened now by progressive knee pain of no obvious origin but portending grave implications. My experience as physician and patient leads me to believe that the stress of awaiting diagnosis is generally under-appreciated. We’ve often heard the misleading phrase “It’s only a diagnostic test”. Several studies have measured stress levels in patients to uncover the real impact of not knowing while awaiting results of diagnostic tests. In one such study, women awaiting results of breast biopsies scored twice as high on standardized tests of stress level compared to women awaiting chemotherapy treatment for known liver cancer. Similarly, men awaiting prostate biopsy results showed much higher stress hormone levels than those who had been informed that they had cancer.

It is only a snapshot, but this story reveals something of our values and raises ethical issues about our healthcare system that transcends politics. The local efforts to protect a star high school football player from facing charges for his reckless prank that resulted in the death of Joseph’s father reflects a prevalent attitude about the primacy of sports. In The Atlantic last month there was a disturbing article contrasting the excellence (and expense) of our high school sports programs with the mediocrity (relative to other developed countries) of our academic programs. It gave examples of schools where expenditures for football or cheerleading students were twice that expended per math student. Exchange students (both US and foreign students) were quick to note these differences.

As a surgeon in a major academic center like UW, I am aware of the excellent care we are capable of rendering. I am also aware that many patients are faced with having to maintain employment in less than ideal situations in order to keep needed health care insurance benefits. This dependency is greatest when the person is encumbered with pre-existing conditions such as Joseph’s. Having visited many countries and participated in numerous international medical programs,I am convinced that our patient care, technology, innovation, research, facilities, and medical schools are as good as it gets. Colleagues from other countries generally share that opinion and come here as post-doctoral students, scientists, and young surgeons to participate and learn. Nonetheless, they do not agree that our health care delivery system is the best model. Uwe Reinhardt is a world famous Professor of Economics and Public Affairs at Princeton who bluntly expressed this discrepancy: “When you go to international conferences, there's always two themes. They admire our medical clinical care, because we're advanced. They admire some of the stuff we try to do with quality control, and they abhor our insurance system. They call it "asocial", "inhumane", "inegalitarian". They really think it's a horror show.” In Sons of the Prophet, Stephen Karam has managed to peel back the layers of the “horror show” and infuse it with sufficient humor to keep us entertained yet mindful of our vulnerabilities and values.