Igneus Auricularius (burning ears)
Wednesday, June 24 2009
Kevin, MD drops a shout-out to me in a post titled, How Patients Can Annoy Their Doctors:
And next, is the demand for a variety of tests, in the mistaken belief that more tests equals better medicine. There are conscientious individuals, like blogger Duncan Cross, who are wary of the risks and complications diagnostic tests can expose patients to. But he’s in the minority. Unfortunately, as some physicians observe, there is a “bias some patients have to just doing more, without any understanding of how more care is not only expensive, but actually often leads to complications, poor outcomes, and lower quality.”
Yay! That’s me. I would add to the list of ways to annoy doctors my personal favorite: start every answer with, “meow”. Oh, good times.
Seriously, I appreciate Kevin’s compliment, but let me be clear: I wasn’t always conscientious. I used to be one of those patients, and I know what it’s like. From 2003 to 2006, I threw just about every drug and test I could find at my disease – including some experimental stuff – and capped it off with massive surgery. And what did I get? Meow basically, a stalemate. It’s not that I never wanted the tests and the drugs: it’s that I’ve already had them, and they didn’t work.
What changed? Meow, I realized two things. First, medical science can’t do everything I want it to. More tests, more pills, more procedures aren’t necessarily going to make my life any better. And that idea has been hard to accept – when every drug ad, every TV show, and every hospital brochure I see keeps telling me the exact opposite.
Second, my doctor isn’t responsible for my health. I am. When I believed that doctors were “in charge”, I found it much easier to do things that were infantile and stupid in the course of my care. Because when someone’s in charge, he’s not going to let you stop taking a medicine you don’t want to take. So what do you do? Stop taking it but don’t tell him. Now that I know I’m in charge, I don’t feel like I have to hide from my physician’s wrath if things aren’t going well for me.
This was, for the most part, hard-won knowledge. I got it wrong for a long time before I got it right. But I don’t think everyone needs to go through that same process. My sense is that the only reason I ever believed these things in the first place was because that’s what our society and system tells sick people about health care: let your doctor take charge, and everything will be okay.
Physicians can do a lot to help their patients form realistic roles and expectations for their treatment; alas, not many do so. I’m not sure why. But I can tell you: I have benefited tremendously from the few physicians who have taken the time to work through my annoying behaviors and help me learn to be more realistic and responsible about my health care. And I think this lines up with the kicker in the article Kevin is commenting on:
“Who cares? The patient is the center of care, not the physician,” said Scott Fields, MD, vice chairman of family medicine at the Oregon Health and Science University in Portland.
“This is part of what is wrong with how we provide care,” he said. “We need to be much more worried about why the patient does what he/she does and much less about how it affects us.”
If you’re a patient, read the MedPage article; try not to do these things. And if you’re a physician, think about why your patients are doing them, and what you can do to help them avoid annoying behavior.
I was so in the same situation as you, and then I came to realize that instead of throwing everything at my cancer, I just needed to accept that it is incurable and find a doc who agrees with me. Getting a doc who is aligned with your philosophy makes a huge difference. It is a hard search and not everyone has the insurance or transit to make it happen. I fly from Chicago to New York for my check ups, my husband’s insurance is miraculously taken at Memorial Sloan Kettering, and we stay in a $40/night condo for patients in Manhattan. It is a relief to go into my appointments now armed with information but no need for attitude.
Meow, if you really want to piss off your doctors, you can give them the copy of this fantastic book “Only 10 Seconds to Care: Help and Hope for Busy Clinicians” by Wendy Harpham, MD. The worst docs are the ones who need it the most.
http://everythingchangesbook.com/