What a messy house has to do with medicine today

I spent this past week worrying that my in-laws were going to divorce me. For sure. No getting out of it this time.

I do not keep a neat house. There are piles everywhere. Piles of books. Piles of papers. Piles of clean-but-unfolded laundry. Piles of mail. Piles of music. Piles (believe it or not) of instruments. Piles of shoes. Piles of coats (it’s cold these days, but varying degrees of cold). There’s a drum set in the living room (because that’s where the piano is). Did I mention the books?

My parents-in-law keep an immaculate house. I don’t think I’ve ever seen a pile of anything in it. Ever. And they’re arriving this afternoon for a weekend visit.

They get that we’re busy. They get that we suck at housekeeping. They have never, in twenty-one years of marriage or the dating years prior to that, criticized us. They focus on our strengths rather than weaknesses. But we all have our limits.

Normally, it’s possible to move the piles around a bit, tidy up around them, and keep a reasonable level of cleanliness in between the occasional deep-clean. But it’s been quite some time since the last deep-clean, and there’s only so much you can do with the touch-ups.

My house epitomizes the problem with the state of medicine today. Stay with me on this.

We’re busy in my family. You should see our Google calendar — so many overlapping color-coded blocks that it actually looks beautiful if you step back and let your eyes go a little fuzzy. So aside from regularly taking out the trash and recycling, cleaning the toilets, and doing dishes and food clean-up, other stuff gets relegated to an as-needed basis. When something gets really gross, we clean it. When something breaks, we fix it. When the toothpaste spatter around the sink reaches a critical radius, we wipe it. But when that goes on for too long without a no-one’s-going-anywhere-until-this-entire-place-is-company-ready cleaning frenzy, it can get really bad.

Bad enough that a visit from your parents-in-law, whom you love deeply, actually frightens you.

A similar phenomenon has been happening in medicine. And, like my house, it’s been getting worse. There’s no time to spend with patients. There’s more and more on the schedule. There are more billing issues to focus on. More regulations. More pressure to see a greater number of patients. More hoops to jump through to maintain board certification. Doctors have time to swab a throat here, adjust a blood pressure medication there, give a quick reminder that someone’s due for a colonoscopy, tell a patient that it would be in his best health interest to lose a little weight. It’s like cleaning around the piles. It can sort of work for a short while, but the dirt builds up.

Every so often, a doctor’s got to sit with her patient and do the equivalent of a deep housecleaning. Find out what’s going on in the patient’s life. Listen to the fact that her son’s been out of work for a year. Maybe that’ll give you the clue that perhaps the reason you’ve had to increase her insulin prescription so much recently is that she’s been giving half of it to her son, who also has diabetes.

My husband and I have spent 8-and-a-half hours so far today straightening and cleaning. We’ve got a little over an hour to finish whatever we’re able before his parents arrive.

It’ll be OK. The bathrooms with which they’ll have contact are thoroughly clean. There is no dust and there are no piles of clothing in the room where they’ll be sleeping. And much of the rest of the house is a heck of a lot better than it was. We’ve done a pretty good job. Not the ideal, whole-house deep clean, but targeted deep clean with broad adequate cleaning. Kind of like a doctor’s visit that focuses on diabetes, high blood pressure, smoking cessation, headaches, ways to reduce stress, healthy eating advice, and ways to fit exercise into a daily routine, The next visit will address the need for a screening colonoscopy, and will describe the preparation for it.

That prep would be the equivalent of our cleaning out our basement. Maybe I’ll wait until I’m 50.