In the old west, men died with their boots on; at sea, captains went down with the ships; and in literature, great heroes died in battle defending God, lady, and country. Today, things are just a tad different. Men today will more likely die with a TV remote in their hand, in their stocking feet, on dry land and defending their god-given right to choose the channel. The remote control device is the modern symbol of male strength, superiority, intellect, and domestic, if not world, power. No wonder Hillary Clinton has nearly taken over the country. Given that the male symbol of domination is the TV remote control and the fact that we cannot mute, shift, or OFF our political forces in real life, I am very concerned about the future of man - no not mankind - just guys. That is a topic for another day.

The topic for today is the TV remote control device. This is the thing that runs the country from 6 p.m. to 1 a.m., seven days per week, every day of the year. By quick calculation, roughly 100,000,000 men clutch the remote for the colossal interval of 250 billion hours per year. Lord have mercy, in that amount of time, men could not only make leather boots, build ships to sink, and write the great novels of the century, they could even have enough time left to compete with Hillary for the political turf of this country. But no, that is not likely to happen and this is America. How do businesses make money out of 250 billion hours of channel surfing time? They build bigger, better, more complex remotes. This does three things: first, it will appear too complex to share the responsibility within in the family. Only the male head of household and perhaps his eldest heir are permitted to hold the remote. Second, the complex remote will give the impression that important matters are being decided by the user. That the issue is Jerry Springer vs. Fox News is never to be mentioned in public. Third, the more complex the remote control, the appearance is given that the device must to be used to the fullest extent in order for one to be considered a leader, a professional, and one capable of being leader of the free world or some such thing for which real men are destined. In reality, of course, the remote simply must do only a few things: turn the TV on and off, change the channel, and change the volume. It could be done with three buttons but how impressive would that be? Women and children would want to touch the remote once in a while and men would risk losing control of the world. I have studied a handful of remote control devices and counted sixteen to thirty-two buttons. Wow, that is impressive. On my remote, I have a button called “action” and I have dared to push it on occasion. I have no idea what it’s for. There is another button called “R-tune.” Beats me. I guess I am not likely to run the free world any time soon as I am not a master of the compex TV remote control.

Medical care is getting to be very much like the TV remote control device. The more complex it is, the more impressive the doctor and the state of care appear. The patient and family are more likely to believe “everything is being done.” Also, the hospital is more likely to buy the idea that the patient “needs to be in the hospital,” Not to be left out, the insurance company is more likely to believe it is getting its money’s worth. Of course, the young Dr. Kildare, wants to impress the crowd that he knows not only how to use all the controls on the TV remote, but that everything he ever learned in medical school will be used for every patient he sees. I will give just two examples of “more complex medicine than is needed.” Consider the use of the intravenous (IV)-line and the fluids dripping into the patient’s body. Nearly every patient in the hospital has a plastic tube, a needle, fluids, and a cumbersome IV pole to which is attached a very hi-tech fluid monitoring device as well as the bag of fluids. This device is much like a TV remote. It looks very imposing, has many dials, but its purpose evolved through some screwed-up line of reasoning. It was noted that thousands of patients were receiving too much or too little fluid because the nurses could not control the rates as patients were off to CAT scan land, etc. This device was created to protect the millions and millions of patients who are admitted to hospitals with orders to have IV fluids. I suggest to you that more than fifty percent of the intravenous fluids given in the hospital are totally unnecessary. If a patient is in the hospital, even for open heart surgery, he likely needs fluids for three days. Check the record, the fluids run for seven days. Every patient entering the hospital with a stroke receives IV fluids? What for? They can drink. Most of it is for show to the above-listed players and it is nonsense. The next time you or a loved one has an IV, request an explanation each day (as the merit falls with time). You will be doing more that keeping it simple. Medical injuries from infections to falls commonly relate to IV fluid concept and devices.

Another unnecessary complexity of medical care is the use of the nasogastric tube. Even TV shows love to show the patient in bed with a clear plastic tube emanating from the nasal passage. The “NG tube” is used to find out what’s in the gut, to take stuff out or to put stuff into the gut. It can be used instead of the IV and this may be a good thing. However, most patients neither need nor benefit from such a device. It is good for show but it is darn uncomfortable. If you ever see one in a patient ask daily why it is there to be sure the NG tube has merit beyond the discomfort it also delivers. It is a regular occurrence in medicine.

Sick patients are admitted to the hospital and all the pressure from the patient, the family, the hospital, the nurses, and the insurance company is to DO things. In the majority of cases, the doctor makes the diagnosis within minutes or hours. Within twelve hours most patient illnesses pass down a clear path to improvement or deterioration. In either case, treatment can be very much simplified. Unnecessary ICU care, antibiotics, IV fluids, vital signs every two-four hours and all that nonsense can be discontinued but it seldom is in an expeditious manner. Patients need time to heal and should be allowed to breathe in the hospital without all the frequently unnecessary complexities of medical care that have only rarely been shown to have disease-reversing merit. It is time for all participants in the medical care process to embrace the concept that efficient, high quality care does not require more that a few strategic activities and close observation. As long as the hospital administrators, insurance companies, trial lawyers, anxious family members and young doctors fight for the remote control device and make things look complicated, errors will be more likely, care more costly , and medicine will not be as it should be, clear and honest. Make a deal with them. They can have the remote if they will just let the experienced physicians practice medicine

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