A woman walks in feeling fine, has a routine cholesterol test, and leaves eleven years later on nine drugs, none of which treat anything she came in with.
Nothing went wrong. That is the machine running exactly as it was built to run.
Day one: she is well. The nurse takes bloods because she has turned fifty and the computer said so.
Week two: cholesterol 6.1. Statin. She arrived a woman and leaves a patient, which is a promotion in this building.
Month nine: her legs ache on the stairs. Told statins rarely do that, and to persist.
Year one: blood sugar has drifted up, which statins are known to do. She is now prediabetic. Metformin.
Year two: metformin has introduced her to her own bathroom. She adjusts her life around it rather than mention it.
Year three: reflux. A proton pump inhibitor goes on, indefinitely, with no conversation about ever coming off.
Year four: stomach acid flattened, so B12 and iron stop absorbing properly. She is exhausted. Her bloods are described as satisfactory.
Year five: tired, aching, foggy, flat. Offered an antidepressant, and takes it, because by now she has accepted that she is simply someone who gets ill.
Year six: osteopenia on the scan. Nobody mentions she was advised at forty to keep the weights light.
Year eight: blood pressure up. Two more tablets, one to fix the ankles the first one swelled.
Year eleven: nine medications and a repeat prescription that renews itself without a human being reading it.
Her cholesterol is magnificent. She has never felt worse.
Not one of those prescriptions was an error. Every single one correctly treated the drug in front of it.
A well person buys nothing. A dead person buys nothing.
The whole business sits in the corridor between the two, and forty years of expertise has gone into keeping people walking slowly down the middle of it.