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Zen And The Art of Car Maintenance

April 21, 2014

Click and Clack, the Magliozzi brothers of “Car Talk”, often get asked questions about life embedded in questions about cars.  I was listening to one of their archived shows yesterday (alas, they are not making any new ones).  It made me think of health care, naturally.  Here’s how:

Every 5,000 miles I take my car in for an oil change.  Every time I go the technician pulls up a bunch of maintenance requirements based on mileage.  I can choose to follow “manufacturers suggested maintenance” or I can just choose to get the oil changed and go on with my day.  My choice is based on a number of variables on any given day:  how much time do I have?  How much will it cost?  How much money do I have, now and in the future?  How much faith do I put in those suggested maintenance charts put together by Toyota?  How much do I care about my car?  How old is my car?  Do I really believe in the consequences of disregarding the recommendations?  How much do I trust this particular garage to competently perform said maintenance?

If you look at this list you notice a few themes.  Hang on, this relates to health care, eventually.

1. Notice how three of those variables involve how much I believe what I’m being told.  How much do I trust Toyota, and Valvoline, and the particular set of Valvoline employees that are working that day?  I recently went to a delightful lunch with a bunch of very smart people sponsored by Trust Across America.  People, I can tell you for a fact that people trust their bankers and their mechanics more than they trust their doctors these days.  For example,  how much faith do I put in the suggested maintenance of my colon, as delineated by the American Society of Gastroenterologists, who get paid for every colonoscopy?  How much do I believe I’ll die an early and grisly death of colon cancer if I don’t follow those rules?  And if I do follow the rules, how much do I trust this particular doctor to do my procedure?  Trust is so important, and needs to be earned.  How do I know to trust Toyota and Valvoline?  Well, I don’t trust Toyota completely, because there scheduled maintenance recommendations could be set up to maximize profits for their dealerships.  So I use my own judgement based on my own beliefs to decide whether to do what Toyota says.  Remember that regardless of their motives, they still know a hell of a lot more about cars than I do.  As for Valvoline, I trust this particular Valvoline store because they always tell me the truth and they do good work.  I don’t think I need to extend the analogy any further, you get the idea.

2. Some of these variables have to do with money.  How much do I want to spend?  Would I have more money later, if I wait?  If I wait, will a small problem become a more expensive problem?  Is this Valvoline charging me more than another one would?  Should I shop around for the best price on air filters?  And the biggie:  Will my insurance cover it?  Here is where car maintenance deviates from body maintenance.  Health insurance takes away most of these questions, except for instances of co-pays and deductibles.  The Affordable Care Act has insured 8 million more people.  That’s 8 million bodies that need servicing, requiring 8 million more units of money, whatever the conversion factors are.  It is no surprise that health care spending is projected to go up.  The ACA doesn’t decrease costs.  It just hides them from more people.

3. There are variables that have to do with my personal values.  How much do I care about this car?  How much longer do I expect it to last?  How old is my car?  How many dings and scratches does it have on it?  Do I really like this model anyway?  How much time do I have to devote to maintenance of this car?  Do I want to sit here in my car while some guys do a bunch of work on it or would I rather go out and enjoy this sunny day?  Personal priorities are so important.  My oncologist tells me I should get chemo and radiation.  Well, maybe I’m old and have had a good life.  Maybe I’m a little dinged up and it’s not so easy to get around anymore.  Maybe I’d rather see my grandkids than sit in the chemo treatment room.  How much longer do I expect to live, and at what cost to me and the people around me?

Trust, money, and personal values.  Basic, and often conflicting, decision-making components.  That’s why health care reform is so hard.


From → Healthcare

  1. Jay Horowitz CRNA ARNP permalink

    Funny, as I began reading I thought you were gonna end up talking about Maintenance of Certification.

  2. Once I saw you mention Click and Clack I had to give 2 thumbs up for this article.

    Next, if you change your own oil, disc (and drum, I have the photos) brakes, air filters, spark plugs, light bulbs, you learn to trust yourself and your judgement and use the “experts” as they were meant to be used. For those times you need a mechanic, they learn to trust you for having some clues on your car.

    You did get points right. One problem on the last one: paternalism and the ego or hubris of docs can get in the way of medical decisions. With all due respect, as an amateur athlete (and I don’t mean I walk a 5K for charity once a year) if I tell you here are the symptoms and you blow me off, later on I develop some pretty severe and life threatening issues because of that ego/hubris/paternalism, expect me to publically state my story.

    Just as if any car dealership, repair shop, etc. hoosed me over.

    My sister explained to me who Dr. House is. I haven’t watched TV since … the ’90s. However, I know the local medical schools’ libraries’ hours for visitors and where the open computers are. God bless these ladies, they have “hooked me up”, shall we say, on occasion, to a little more “help” than the regular body off the street gets.

    As not all cars and their drivers alike, nor are patients and doctors.

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    • The only online forums I know of are other blogs, including KevinMD and The Health Care Blog and Wright on Health, among others. Thanks for reading!

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    • Thanks for reading! I too am an aspiring writer. Expect a lot of rejection… A blog is great for starting what the industry calls “an author platform”. WordPress is awesome, don’t pay for anything. The only concern some have had with wordpress is if your blog gets really big and popular and you decide you want your own domain name theoretically wordpress could demand to keep your name. I wouldn’t worry too much about that. After you set up your blog, which is super easy, you just have to start posting as much as you can. Good luck!

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