In medicine, we usually confront two types of illness, one for which there are treatments and cures that fully resolve the condition and one for which no cures are available. In the latter, we spend our effort caring for the patient on a long-term basis to help them function as best they can with their chronic conditions.
This division is important, because it explains a great deal about how physicians choose their career paths in medicine. To oversimplify, many surgeons enjoy the "cut it and cure it" model, because they gain more satisfaction from seeing the patient over a shorter period of time and helping them to resolve an issue quickly, for example, cutting out
an inflamed appendix. An internist, on the other hand, must cope
with many conditions such as diabetes, hypertension, heart disease, and
asthma. Most of these patients require regular followup appointments
and medication adjustments to best manage their conditions and enhance
their quality of life.
In more than a quarter century of
travels through the medical landscape, I've undergone my own
transitions in starting out as someone more interested in managing
chronic care, as I trained as an internist. Then, I spent a decade
working in the field of emergency medicine, where time is always of the
essence, and the patient often walks or is carried in and out of your
life in a matter of hours. Shortly after entering emergency medicine, I
was introduced to sleep medicine, where I saw how this field offered
opportunies to do both: cure patients or provide them with chronic
care. You see, sleep disorders are frequently long-term problems, but
the treatment of sleep disorders can yield a state of continuing
success, not often seen in other areas of medicine.
remarkable example of continuing success occurs in patients with
sleep-disordered breathing who successfully use positive airway
pressure (PAP) therapy. The amazing thing is that whenever the patient
uses the PAP device, they are "cured" of their condition on that
particular night of sleep. But, what's even more astonishing to doctors
is to see the results in that person after they have used PAP therapy
regularly for several months. The individual looks healthier and
younger, and they often interact with more energy and alertness. It
appears as if they have been "cured" of the sleep-disordered breathing.
But, if they don't use the mask the next night or for several nights or
weeks, it soon becomes apparent that they have reverted to their
previous exhausted state.
So, should we call this a cure or not?
The condition is always there, but it responds dramatically to
treatment whenever you use the treatment. In our field, even though we
know that PAP therapy works mini-miracles, we now are realizing that
many of our sleep breathing patients need much more regular followup to
insure that they attain this level of "continuing success" or "cure."
So, I think it's fair to say that sleep disorders do represent chronic
conditions, but in the case of sleep breathing, we have a treatment
that yields results far superior than what is typically seen in
managing other chronic conditions in medicine.
This power to help
patients resolve their sleep problems is very invigorating, rewarding
and motivating for sleep professionals. However, there is one downside
that often is not talked or written about. We must also engage with
those patients who could have made dramatic sleep health gains but who
choose for various reasons not to use their PAP treatment device. When
these patients also suffer from diabetes, hypertension, and heart
disease, three conditions which by the way appear to improve with
regular PAP therapy, it is very discouraging to view the deterioratoin
in the patient. It's not that PAP treatment of sleep breathing will
solve all their medical conditions, but it plays a big enough role to
make a difference in their overall health.
So, just as it is an
incredible "high" to see someone make extraordinary health gains with
PAP therapy, it is a demoralizing "low" to see someone reject or
dismiss a treatment that just might save his or her life!