I’m not gonna lie, I miss the olden days. Not in the same way most mean when they say this. I miss something I never actually experienced, that being the time I’ve heard about when patients just took what the doctor said at face value and didn’t question it. Admittedly I’ve also heard how at times this went to extremes that today seem absurd. For instance, I’ve interviewed octogenarians who have had surgeries where organs were removed and they weren’t sure what procedure had been done! Or patients who lack understanding of their condition because they didn’t feel they had the right to ask questions. Personally, as a child and adolescent, when the ever-bow-tied Abraham G. Eisner, M.D., gently placed his cold stethoscope on my chest, I had a confidence that he knew what he was doing and I would be benefiting from his knowledge, experience, and care.
I’m kidding, of course, about the part of wanting people to just put up and shut up when I offer my sage advice. Faulty, biased, or incomplete internet search information aside, the teacher in me enjoys the challenge of paring down complex medical situations into bite-sized pieces for patients’ consumption. I really enjoy putting the particular complaint or situation into the context of overall health, explaining the anatomy and physiology involved. It’s fun to watch the lights of understanding come on in the previously dark room of pain or suffering.
I admit though, at times, I feel that maybe we’ve swung a bit too far in the other direction. Total acceptance has been replaced by significant skepticism, as if the entire medical community has met and is in cahoots with each other to try to pull one off on unsuspecting patients. At times also I find an individual’s assessment of her ability to understand complex issues is overestimated. The mindset seems to be: If I can read about it, I can understand it. But information is not necessarily education. True education means also having the context to apply the new information in a meaningful manner.
So, I’m submitting a request for a middle ground. I used to tell patients, “We’re in a health care car. You’re the driver and I’m the map,” but now I’ve updated that to, “You’re the driver, I’m the GPS.” In either case I want the patient to know that I realize I can talk all day and give the same advice one would get at Mayo Clinic, but the GPS (so far) doesn’t drive the car. It’s the patient that has her hand on the wheel and feet on the gas or brake of her health care vehicle. We’re ultimately going where the patient wants to go.
As a physician who is purposeful in trying to listen to nuances of a patient’s history, I am always surprised when a patient returns from a consultation with a specialist who has basically approached the visit with the words or at least the posture of, “I’m the specialist, this is what I think. Don’t like it? There’s the door.” Now, I get it…to some degree. Why go to a specialist if you don’t want the care they can provide? If you’re never going to consider having surgery on that knee, then it’s probably not wise to make an appointment with an orthopedic surgeon. This is certainly a minority of cases, but I would advocate for a bit of a softer approach, even if the outcome is the same.
It can get confusing. At times I will hear a strong objection to what I suggest as the best next step. “I hear you doc, but I read this and I think this is the better thing,” or more honestly, “I don’t want to do that. This person on the internet said…” The next patient may say something along the lines of, “I don’t know. You tell me. You’re the doctor!” It’s baffling when a patient trusts her body to a collection of supplements for which there is no oversight of the production of those supplements, but has strong convictions against a medication that has undergone rigorous testing and study.
Admittedly drugs have made it through the multi-layered process of FDA approval and still caused problems down the line. But throwing the prescription drug baby out with the Big Pharma bath water is puzzling to me. The process for drug approval is not perfect but it is good and rigorous, as it should be. In addition, remember that the criteria to put information out on the internet for consumption is precisely non-existent.
The best approach is something along the lines of:
- Express your problems and concerns as concisely as you can while still being thorough, knowing that even in the best circumstances face-to-face time is limited.
- Assume the provider is going to use her knowledge and experience to give the best advice.
- Ask questions for clarification for anything that is confusing or conflicts with other advice you’ve received.
- Be realistic in the expectation for the provider to answer questions about things you’ve looked up prior to the visit. Keep in mind that time and backgrounds prevent full explanations on every topic. Avoid challenging the physician with information from special interest groups that have no real medical credibility.
- Keep the discussions going with your providers. However, any physician worth her salt will admit she has not cornered the market on all there is to know.
Ultimately there needs to be trust between a patient and the physician or provider, just as there needs to be trust between a driver and the GPS. If that two-way confidence is lost, it’s not likely the directions given will be well received or taken. Therefore, it’s time to seek advice from another trusted source. The most important piece is this. We all do better in life with some guidance along the way. One of the best investments you can make in your health is to find your trusted “GPS” that can tell you “This is the right road worth taking!” when your journey grows chaotic or desolate. The decisions you make are up to you, but you’ll never regret having a trusted beacon to guide you path.
