OP-ED

Clinical Man *

Pharos Cover Art

In 1994, I recorded a fictitious interview with the person whom I imagined to be the last well person on earth. (1)  I mistakenly thought well people were disappearing and I wanted to call attention to their disappearance. I missed the big picture and now want to correct my misconceptions. Well people are not disappearing; instead, a new species of man is emerging:  homo clinicus.

An evolution of the symbiotic relationship between man and medicine has been going on for some time. Lewis Thomas deserves the credit for an early spotting of the new species, first observed in America. He called our attention to this phenomenon in the 1970s.

Nothing has changed so much in the health-care system over the past 25 years as the public’s perception of its own health. The change amounts to a loss of confidence in the human form. The general belief these days seems to be that the body is fundamentally flawed, subject to disintegration at any moment, always on the verge of mortal disease, always in need of continual monitoring and support by health-care professionals. This is a new phenomenon in our society.

There has been a progression of terms for this new species. First, there was the “early sick” then “the worried well.” That was followed by “the worried sick.” We now have arrived at a definable new species that differs from pre-clinical man.

Pre-clinical man lived largely with medicine out of his consciousness. In fact he lived to avoid medicine. Those of us who are still pre-clinical will recall the earlier saying, “An apple a day keeps the doctor away.” That is almost pure pre-clinical thinking. Pre-clinical man only went to the doctor when he was sick or injured. It was up to pre-clinical man to decide if he was sick or well. It did not take a physician to make that decision. If he felt all right he was well; if he felt sick he was sick. Not so with clinical man. Feelings are no longer a reliable guide to health. Feeling good is not enough. There must be objective data that nothing is wrong. That’s the problem. Something is always wrong if you look long and hard enough at or inside any human. As a medical resident told a colleague, “A well person is someone who has not been worked up. We can always find something wrong, if we look hard enough.”

Clinical man is neither sick nor well. He is simply in clinical limbo. As you will see in the definitions of this new species below, he is always under medical surveillance. Clinical man requires it. More importantly, medicine requires it. Clinical man either has something that is not quite right or something that needs to be rechecked.

Medicine and man have evolved in a symbiotic manner ­­– like the whale with those little fish that swim in and out of the whale’s mouth. The fish need the whale for food particles and the whale needs the fish for dental hygiene –something like that. There is nothing strange about this symbiosis of medicine and man.  Big medicine needs clinical man and clinical man needs big medicine. That’s just the way it is. Where would all the endoscopists be without clinical man? And what about all those proceduralists who do interventions and biopsies? What would we do with all the CAT scans and MRIs and PET scans without clinical man? How would all the surgi-centers and imaging centers and stand-alone diagnostic centers survive without a long line of clinical men? Don’t forget the insatiable needs of big pharma and the relentless mongering of created, pseudo diseases on television.

Clinical man goes to the doctor when not sick. That’s part of the definition of the new species. No longer able to decide by themselves, they come in increasing numbers to find out if they are sick or well. Some even demand to know what disease might loom in the future for them.

Here are a few of the characteristics of clinical man:

  1. Knows his cholesterol level within 10 milligrams percent.
  2. Has been biopsied in at least one non-palpable organ by age fifty.
  3. Has been biopsied in a palpable organ by age forty.
  4. Has had at least one major orifice endoscoped within the past twelve months.
  5. Is always waiting on a biopsy report or a repeat of a borderline or false positive lab result.
  6. Never goes more than twelve months without medical contact.

How did this evolution from an avoidance of medicine to medicine becoming a necessity occur?  It is actually quite simple; medicine has been assigned successes by television and the public that are not attributable to medical care. Nearly all of the increases in health and life expectancy from birth are traceable to public health measures, clean water and milk, vaccinations, and a myriad of positive effects of the age of modernization.

It is a strange irony that at a time of maximum health, more people than ever are coming to see doctors.  Preclinical man will soon be extinct.

1.         Meador CK. The Last Well Person. New England Journal of Medicine 1994; 330: 440 –41. ­­
2.         Thomas L. On the Science and Technology of Medicine. In: Knowles J, editor. Doing Better and Feeling Worse: Health in the United States. New York: W.W. Norton; 1977: 43.

* The term Clinical Man includes both the male and female gender.

Clifton Meador is a professor of clinical medicine at Vanderbilt. Clinical Man originally appeared Oin The Pharos of Alpha Omega Alpha Honor Society, November 2011. Republished with the author’s permission.  

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Tom EmerickPreclinical WomanLorliMDCindy WilliamsDavid Recent comment authors
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Guest

Heads up, fellow commenters. I came across a must-read for anyone following this thread. Oliver Sacks — the real one played by Robin Williams in Awakenings — is dying with cancer. This link to his personal experience, in his words, is one of the best pieces of prose I have come across lately. It’s not quick or shallow. But it’s worth whatever undistracted time it takes to read it. This is highly recommended reading. Satisfaction guaranteed. Here’s a snip: On Monday, February 16, I could say I felt well, in my usual state of health—at least such health and energy… Read more »

Preclinical Woman
Guest
Preclinical Woman

This is very much in keeping with my perspective as a 71-yr old ornery female who has avoided all the marketing. No hospitalizations, scopes, prescriptions, tests, annual exams. Something will kill me eventually but it won’t be overtreatment. “I will live the time I have. I will not spend my days prolonging my years”

Guest

*Clicks “LIKE”*

Tom Emerick
Guest
Tom Emerick

Dear PreclinIcal Woman,

Good for you. You’re an inspiration. The wisest doctor I’ve ever know once said that people should stop worrying about what’s going to kill them and start enjoying the journey. Ironically, if we follow that advice we may live live longer AND live better,

Cheers,

Tom

LorliMD
Guest
LorliMD

David,
You are feeding the deluded obsession of the Clinical Man described in the original article. Why does a patient need A1C if they check FS blood sugar appropriately? How often would A1C be drawn? Surely not more frequently than every 3 months or so.

I would be interested to know why the values for desirable serum cholesterol have been going down again and again. Could this be something todo with Big Pharma’s powerful presence in Washington?

David
Guest

Scenario 1: You have insurance, you see your doctor to get some lab tests but when you get your bill you notice that your insurance company didnt cover it…. Why you ask because your doctor thinks you’re not at risk for this type of lab test. Now you are stuck with the full bill. Scenario 2: you dont have insurance and you need to get labs done, you go to the clinic see your doctor, order some labs and now you have a massive bill, doctors bill plus co-pay–Yikes! Scenario 3: you have a high deductible and you must pay… Read more »

Guest

No mention of signs or symptoms.
WTF? Trolling for business on a Sunday evening?
The comment illustrates the point of this post.
You’re in the wrong line of work, David (at the hot link to New Century Labs). If you’re pitch is “peace of mind” you should be selling life insurance, not health insurance.
Thanks.

David
Guest

Thank you John. The company provides labs at discounted prices and not health insurance. “peace of mind” comes from knowing that you can get an A1C lower than insurance companies will support on a monthly basis. If you are in support of healthcare then you would agree that people who are as old as you may need to have healthcare a lower cost, right?

Guest

Clifton,

High praise keeps coming in for my reposting of this article.

(Tazia, pls excuse my misspelling of your name in previous comment.)

Cheers

tom

Clifton K Meador
Guest

Maggie. Thank you. Clifton

Guest

Clifton– a great post!

“An apple a day keeps the doctor away” perfectly describes how people use to think of medical care (something to be avoided, if possible))

Now, they take perfectly healthy 14-year-olds for a “full physical” and boast about how many specialists they see.

Thank you.

Tazia K. Stagg
Guest
Tazia K. Stagg

Dr. Meador, for what purpose did you publish this?

Tazia K. Stagg
Guest
Tazia K. Stagg

What was the author trying to accomplish?

Guest

Tanzia…I think Clifton was trying to point out that many Americans have a healthcare obsession.

Cheers

Tom

Guest

An important thing to remember is that medical care can only deal with about 20-25% of the things that can kill you before age 85.

The rest is simply beyond the reach of physicians.

Cheers,

Tom

Guest

Clifton, my email address is: tom.emerick@emerickconsulting.com

cheers

tom

Guest

Clifton,

Here is but one response to the post:

“Super interesting find Tom, and I couldn’t agree more”. This came form a CEO of a health company.

If you’d like to discuss my number is 479-957-4902.

Cheers,

Tom

Guest

Clifton, I posted a link to this on my blog. I’m getting one of the best responses to a post on my blog in five years. Your concept really touched a nerve with my readers.

Congratulations.

Cheers,

Tom

Clifton K Meador
Guest

Tom. Please share responded to your blog. Clifton

Sue Wood
Guest

Clinical (Hum)Man has a silver lining. If we had a self-care system, she’d have less touch points & care

LeoHolmMD
Guest
LeoHolmMD

This is a good point, but I wonder if self-directed care would increase or decrease utilization? I think it will depend on the person and the level of advertisement. GERD, for instance, has gone direct to consumer. Now you can get treated without physician contact or endoscopy, but you also miss the opportunity to explore the causes. As Larry The Cable Guy will tell you: Now you can eat anything you want and not get heartburn. Perhaps reducing the amount of beer and BBQ ingested will have other positive health effects when the immediate symptoms are not masked. Perhaps your… Read more »

Guest

To Clifton Meador,

Excellent article. Congrats. May I have your permission to post a link to this in my blog, Cracking Health Costs?

cheers,

Tom

clifton k meador
Guest

Tom
Please do post, thank you,
Clifton Meador