Tuesday, April 13, 2010

One Size Fits None

Photo by Zen on Flickr

In the last few days, I've had a few conversations that lead me to expand my dislike of "one size fits none" even further. I used to say "one size fits none" to refer to clothing in stores that says "one size fits all". Really? I don't think so. Unless it's a scarf, apparel needs to be sized for a 5 foot tall female or a 6 foot tall male and the many sizes in between.

This week, the conversation turned to health care. Did you know that prescription drugs are, by and large, tested on males (likely caucasian)? The NIH does require "inclusion" of women and minorities, but there doesn't seem to be an agreed upon minimum percent of participants...but I digress....(in fact, there's been such an influx of information on this topic, that I'll set up a separate blog post shortly)

Again, normal dosing is supposed to work just as well for 300 lb. males, 150 pound males and females and 100 lb. 4 foot 11 females. I'm not a trained scientist, but I'm pretty sure the math on that creates incredibly varied results. Interestingly, there is a new trend in personalized medicine also talked about in Business Week.

And then there are protocols and provider care. When an individual walks into a doctor's office with a pain in her knee - the doctor should listen. (a recent New York Times article talks about just that). Listen not just to what the pain is and where and when, but also listen to what she's done in the past that felt better, what felt worse. Who has treated it and why. Many doctors, upon hearing, knee pain, will immediately go to the Rolodex in their heads from med school, pull up the "knee pain protocol" and prescribe exercises, pills or surgery - depending on the relevant issues.

However, anecdotal information shows that very often, providers don't listen, really listen to what the patient says. A certain medication has already shown to be ineffective. Using ice made it worse. It always hurts after a particular exercise.

We are people, individuals with a complex set of feelings, pains, biology and psychology. Using the "one size fits all" protocol doesn't work for many patients. Using the apparel metaphor, a size 5 female foot will never fit correctly into a size 12 shoe, don't assume the person attached to that size 5 foot has the same issues as the size 12, either.

No comments: