A lot has changed in medicine, and in a relatively short amount of time. I mostly blame the internet. The rare, dramatic story gets the headline (and the Facebook shares) causing patients to think that Predators in white coats are lurking around every corner to perform unnecessary procedures or misdiagnose their illnesses simply out of meanness. Unfortunately, “Doctor Practices Good Medicine, Doesn’t Prescribe Antibiotics, and Patient Gets Better Anyway” just doesn’t make for a very sensational headline. But good medicine happens every day, everywhere. It’s so much more common than we are led by the media to believe.
Usually within the first thirty seconds of a patient visit, I know which way things are headed. The best physician-patient interactions I’ve had have always centered around mutual respect and appreciation. I leave these interactions feeling refreshed, invigorated, and at peace with my decision to go into medicine. The patients leave having gotten the best version of me—the smartest, most attentive, most hard-working me that there is. It’s a win-win.
So, what do you need to do to get that version of your doctor, and not the exhausted, underappreciated, unfulfilled version? Not much, it turns out.
1. Don’t Lie. It doesn’t do you any favors to be untruthful to your doctor. Unless you tell your doctor something along the lines of “I want to kill my spouse and I have a loaded gun in my car which I am going to use for said crime,” whatever you say during your visit is completely confidential. And certain things can actually factor into medical decision-making. For example, a thirty-year-old who complains of chest pain is very unlikely to be having a heart attack, unless…(wait for it)…he’s been doing lines of coke. Then, a big ol’ heart attack is back on the differential. And heart attacks are treated a little bit differently than your run of the mill musculoskeletal chest pain.
2. Do treat your doctor with respect. Now, I’m not saying you need to bow and kiss his ring every time he walks in the exam room. I’m just talking about extending the same respect you give to the people who bag your groceries and cut your hair. Respect them when you think they look young (they have been through years of training and probably still remember most of it), respect them when they say they don’t know (which is much better than pretending they know when they don’t), and respect them when they don’t order every test known to man (they probably have a good knowledge base and/or physical exam skills and don’t require the extra reassurance from unnecessary and sometimes harmful tests). You don’t have to trust them blindly, just respect them.
I’m going to drop a truth on you here that might just blow your mind: Doctors are human. And, being human, most of us tend to want to avoid conflict. If you argue with and yell at and threaten your doctor (or your family member’s doctor), they will naturally want to spend less time around you. Or they may acquiesce and write a prescription for a medication they don’t feel is necessary and could end up harming you. Your relationship with your doctor should be a therapeutic one. It should not be approached with the same angst as a call to Time Warner Cable’s customer service department.
3. Don’t mention Google. Under any circumstances. Ever. Look, we both know you Googled your symptoms before coming in. Let’s just agree to not talk about it, okay?
Don’t get me wrong, you can ask all the questions you like. We love that, because how else would we know what you’re really worried about? Questions like “Do you think this could be cancer?” or “Do I need a CAT scan?” can really open up a great dialogue. But don’t underestimate the years of school and training we went through to get where we are, and the experience and knowledge we gather on a daily basis by caring for patients. If we could treat you using a quick Google search…well then, you’re wasting the heck out of your co-pay.
4. Do leave your demands at the door. Not to be harsh, but it has to be said: Your doctor’s office is not McDonalds, and Augmentin is not a Big Mac. There are reasons why most medications require a doctor’s prescription, reasons like the potential for serious side effects, the possibility of drug interactions, and the need for close monitoring on certain medications.
One of the hot-button topics is medicine right now is antibiotic resistance. Bacteria
multiply at a rate so fast that they can develop resistance to an antibiotic simply by chance through the random mutations that occur in their DNA during replication. Therefore, any time you expose a bacteria to an antibiotic without entirely eradicating it, you introduce the possibility of resistance (that’s why you need to take every single pill in the bottle, even when you’re feeling better). This is relevant because bacteria are developing resistance faster than we are able to develop new antibiotics, therefore resulting in the “superbugs” you’ve heard so much about. By and large, these are just “regular bugs who are now too smart for our usual defenses”—but that doesn’t have quite the same ring to it, does it? Anyway, all that to say when your doctor doesn’t want to prescribe antibiotics she’s not trying to punish you or be withholding. She’s trying to practice responsible medicine. Please, let her do her job.
Another subject that consistently creates tension in the doctor-patient relationship is narcotic pain medication. The availability of these meds has become such an issue in this country that the Obama administration has asked for $1.1 billion from Congress to address the issue. And nearly four in ten people know someone addicted to prescription pain meds. Every time a doctor writes a prescription for opioids, he should ask himself, “Is this absolutely necessary, or can we get by with something else? Is this worth even a 1% chance of creating an addict?” Because a 1% rate of narcotic abuse is significant when you treat hundreds of patients a week, which many physicians do. And potential addicts are not always easy to spot. They don’t wear a sign on their chest or come in with track marks up and down their arms. They often have good jobs, families, and responsibilities. They have a lot to lose. It has much less to do with willpower or a moral compass than you might think, and more to do with a genetic predisposition (that a patient wouldn’t even know they had). I’ve heard the story before, and I’ll hear it again, of a person who lost everything after a seemingly innocent prescription for Percocet totally derailed their life.
5. Do ask questions. Wait, didn’t I say that already? Yes, but this point is important enough that it needs its own number. Medicine used to be paternalistic. The doctor said, so the patient did. The pendulum has swung very far from that norm (perhaps too much, but that’s a conversation for another day). In today’s healthcare climate, when you have too little face-time with your doctor and way too many tests, drugs, supplements, and diet restrictions for anyone to keep up with, you MUST ASK QUESTIONS. Questions like: “Why does this medication work?” or “What could happen if I don’t have this test?” or “Are there any other things I could try?” We have no way of knowing what your day to day life is like, what worries you, what’s important to you, or what might keep you from following your treatment plan unless you communicate your concerns. We have no idea which part of our conversation you didn’t understand unless you ask.
Honestly, most of us love teaching, love sharing what we know. I would much rather teach a man to fish than give him a fish any day.
6. Do follow your doctor’s advice. Or at least know why the advice is being given and what the potential consequences are of not following said advice (see above point). It is so sad to see a patient diagnosed with stage 4 colon cancer that could have been detected at stage 1 if they’d had their screening colonoscopy. It’s even sadder to realize they never understood the purpose of the colonoscopy.
Same with quitting smoking, losing weight, taking your blood pressure pills, eating right, and controlling your blood sugar. Patients who take ownership of their health often stay out of the hospital and even their doctor’s offices for the most part. Practicing a healthy lifestyle significantly limits the amount of healthcare and medications you have to receive over your lifetime. We know that high blood pressure and cholesterol leads to strokes and heart attacks;
uncontrolled diabetes causes chronic kidney disease, amputations, and dialysis; and obesity complicates nearly every other chronic medical problem. And I should take this time to mention that YOU CAN CURE type 2 diabetes by losing weight.
Believe it or not, physicians do prescribe lifestyle changes, but these recommendations often fall on deaf ears. And sometimes the proverbial horse is already out of the barn (or at least we need to bridge the gap until we can coax the horse back into the barn), and we must prescribe medications—medications that cost money and may at times have unpleasant side effects. But we don’t do it to line the pockets of the pharmaceutical industry (no, they have direct-to-consumer advertising for that). We do it because we know what your future holds if we don’t. We’ve seen it over and over and over again.
7. Do be open to suggestions. I once took care of a patient who had respiratory failure. She declined not one, not two, but three different therapies that could have quickly improved her symptoms. Then, as she continued to struggle for air, she said to me, “It seems like there would be a medication that could make me feel better right away.” I wish I was exaggerating.
You don’t have to agree with everything your doctor says (I feel like I’m beating a dead horse, here, but I want it to be very clear that we don’t expect that), but if you are going to shoot down every suggestion she makes, you might as well save your money and your doctor’s time.
You go to a doctor because they are trained to take care of the human body during times of illness. You may not have experience with a certain ailment, but you can rest assured that your doctor almost certainly does (and they should tell you if they don’t). Most of the time, their prescribed course of therapy—while it could seem strange or inconvenient to you—is a tried and true, common, safe, and effective treatment.
Bottom line, if you do choose to seek a medical opinion, please be open to what that might entail, be ready to hear some things you may not like, and don’t expect to dictate your own care. And always remember, you catch far more flies with honey.
Bernstein, Lenny. Four in 10 say they know someone who has been addicted to prescription painkillers. The Washington Post. 24 Nov 2015.
Harris, Gardiner. Obama Seeks More Than $1 Billion to Fight Opioid Abuse. The New York Times. 2 Feb 2016.
*The author of this piece does not assume any affiliation with the author of The 7 Habits of Highly Effective People, Stephen R. Covey.