Geriatrician and wound care specialist Jeffrey M. Levine, M.D. has been watching the TV lately:

I first noticed this phenomenon while watching the world news on a weekday after work.  It was a commercial for a new diabetes medicine that showed overweight people dancing at a barbecue, cooking and enjoying life.  How different this was from my day in the wound clinic, where I saw patient after patient with obesity, diabetes, and nonhealing wounds, as well as other dire medical complications.


Surely you’ve seen these direct-to-consumer pharmaceutical ads. They appear abundantly in the early evening hours, as Dr. Levine observes:

Every one of these commercials has the FDA requirement of revealing side effects, and the list seems to go on forever.  This list is usually delivered by an off-screen voice while visual images of sunsets, parties, and genial family get-togethers are depicted.  How does this impact the image of disease in the mind of the public, most of whom are unfamiliar with the true, harsh reality?  I believe the juxtaposition results in unrealistic expectations that modern medicine can transform disease and death into a pleasant and aesthetically pleasing experience, and perhaps banish them entirely.  False expectations indeed, as anyone who works with aging, disease, and death can tell you.


The truth is that being sick stinks; living with a chronic medical condition is hard, aging even harder, and no one wants to die before their time. The false images that lead to unrealistic expectations set physicians up for a “battleground at the beside”:

These unrealistic expectations collide with reality when people experience the raw truth of illness, aging, and the processes of dying.  The result of the collision is battles played out daily across the nation in hospitals, nursing homes, and doctor’s offices.  When slick images collide with reality, the discomfort of internal contradiction takes over, which is translated into anger and blame, with the health care system at fault for not living up to expectations.  Psychologists call this phenomenon “cognitive dissonance.”


Tamping down unrealistic expectations is a challenging job for any physician, requiring as Dr. Levine notes, “hours of discussions with patients and families regarding the realities of aging and death.” It would be unrealistic for any young physician entering the field of medicine to expect anything otherwise.


(Google Images)