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Costly Decisions

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My friend went off his meds. The drugs that controlled his blood pressure made him feel sluggish. The drugs that decreased his clotting risk were part of the handful of pills that simply got dropped from the regimen. The stroke he suffered two weeks later was probably avoidable. His road back to full recovery remains uncertain. Regrets don’t begin to tell the story.

Many of my patients stop taking their arthritis medications. They stop working at their joint mobility exercises, their balance practice and their muscle strengthening regimens. They prefer to play rather than train. Some prefer to do neither and become sedentary. And it is not just my patients. The most unfilled prescriptions are medications for headache (51 percent), heart disease (51.3 percent) and depression (36.8 percent). Annually, 125,000 deaths are reportedly due to unfilled medications.

Some of my other patients take their sports to extremes. No sooner have they recovered from one injury, they are pushing the limits of the next, all the while setting new personal records. Frequent flyers in the operating room, they accept their setbacks as the cost of their glory.

Even some of my post-op patients ignore my advice to limit the weight bearing on their repaired knee while their cartilage regrows. It’s understandable. The rehabilitated joints feel good. The long-term damage is unseen. The benefits of the regenerative surgery may not be fully achieved with such early activity, but my cautions fall on overly aggressive ears. It is unfortunate, because surgery is often only as good as the rehabilitation exercises that follow.

Some of my patients overeat. The immediate pleasure literally outweighs the consequences. A slowly growing belly becomes part of their self-image. Though their friends may notice, the transformation proceeds silently — often because it is not PC to tell someone they are getting obese.

My most careless friends smoke cigarettes. Some do this stupid activity 20 times a day. How can this repetitive self-insult be justified? They know it is destructive to all human systems, eventually fatal and smells bad. It defines people as stupid, maybe even deplorable (though today we can’t use that word). Yet they go on.

We all do stupid things. I try not to do them too often. And I try to limit my stupid activities to those with minimal consequences. When the activities lead to damage to myself, I pay the price. When others have to pay for my stupidity, it is I who have behaved irresponsibly. The difference is what determines the success or failure of our communities.

My friend may recover — but others sacrifice time and effort to bring him back. So look in the mirror when you question the cause of rising healthcare costs.

Dr. Kevin R. Stone is an orthopedic surgeon at The Stone Clinic and chairman of the Stone Research Foundation in San Francisco.

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