Wednesday, July 30, 2008

Well, Dr. Rob did it again, and I just had to put in my two cents worth.

Sorry, Dr. Rob. Ok, not really, but I don't mean to be a thorn in your side. Do you trust your doctor? What a question and you have no clue how I reined in all I wanted to say. The short answer: NO.

The long answer: read my blog. Ok, I can get you started:

Vituperation [vahy-too-puh-rey-shuhn, -tyoo-, vi-] is.......

What did I say to Dr. Rob? Well, really to all the doctors who read his blog, not just him. (He just has the guts to bring up the tough stuff.) I tried to convey a lot in as few words as possible. Obviously, I was pretty wordy anyhow.

I used to believe doctors were infallible. Ok, close to it, anyhow. But my battle with Cushing’s disease (excuse me for bringing it up again, Dr. Rob, but it’s what I know) tainted my belief in just about all doctors. I won’t go into details. You don’t need that. You didn’t cause it. But, I believe, like all people in all walks of life, there are good and there are not-so-good practitioners. That goes for doctors, too. And I believe a person has to be well-informed and take charge of her medical knowledge in order to prevent inadvertent negligence.

I doubt you trust all auto mechanics, computer repair persons, or hair dressers/barbers. Why should we, as patients, trust all doctors? We can’t. Peggikaye has some excellent points above. Just as you have to have some knowledge about your vehicle, computer and what you think your hair dresser should or shouldn’t do, so should we about our doctors.

I very much understand why doctors would be upset with “know-it-all” patients who don’t listen to them. But perhaps the same is happening in reverse. Isn’t half of medical care actually listening to the patient? And what makes doctors think that we are so stupid we can’t learn, too? (Present company excluded, of course.) Just because I chose a different path in life does not mean I can’t study and learn what they learn. Perhaps I know more than many doctors on some subjects. I guarantee Peggikaye and I do on certain subjects, especially when it comes to our bodies and illnesses.

How often do doctors really read the new research and keep up with new diagnosis and treatment options? I believe the answer is “not nearly enough”. That is why the patient has to research and then find a doctor who has or who is willing to learn. That’s what I did. I found a specialist all the way across the country who knew what was wrong with me. I found a PCP who was/is willing to learn. It’s a good combination, but I suffered a lot until I did. And the delay almost cost me my life. Am I angry. You bet. At you, no. At many doctors I saw in the past? Yes. At doctors in general? I don’t know. I don’t know with whom to be angry. Medical schools? The “system”? What? Whom?

What is the answer to the above? I’d love to hear it. I know I’m only seeing it from my side, but no doctor has been willing to share with me from his/her side. I’d like to suggest some posts on that from the doctors on these medical blogs.

(As a sidenote, I have never been disrespectful with any doctor. I have been angry, however. I have never minded paying and always pay what is asked, but I do mind when I don’t get anything for the expense. And that is the difference. I had to learn to be assertive and proactive.)

Respectfully posted.

P.S. I forgot to mention that I've also thanked the doctors who have helped me. And I've always tried to "pay it forward" with any help I get.

P.P.S The rose picture was taken by my mother. It's a old-timey rose that she has propagated from one her mother had. Her mother propagated it from an ancestor, but I'm not sure which one. It's my favorite rose of all time. Nothing fancy, will grow anywhere, and it signifies the beautiful roots of my family. (I love my family, can you tell?)


  1. That is why I did it - to generate discussion. Your post and some of the comments (so far) have definitely given me ample material for another post. Let me give you a preview of some of my thoughts:
    1. Trust is not an all-or-nothing thing. If you go to a doctor, you ARE showing some trust.
    2. I get nervous when patients have too much trust in doctors. Nobody deserves your complete trust.
    3. There are things doctors do regularly that either win or undermine trust from their patients. Just wearing the title does not earn the right to be trusted. You must earn it.
    4. Patients trust themselves too much sometimes. They think their knowledge is better than their doctor's. This is as insulting to doctors as a doctor's arrogance is to patients. There must be a balance - where the doctor realizes the patient knows him/herself more that the doctor does, but the doctor knows medicine more than the patient does. The give and take in this regard is the bottom line of what makes a good doctor-patient relationship.

    I don't blame you for not trusting - given what you experienced. But to get the most out of your relationship with a physician, an environment of distrust is toxic, and will undermine the care you get. Limited trust is fine, but distrust (or mistrust) is not (nor is blind trust).

    Great discussion.

  2. Love your thoughts. I hope you can generate more discussion among the doctors who read your blog. I value their input. You won't have a problem getting patients to give input. What I found very interesting, though, in the comments being generated in response to your piece is the combination of patient/doctor and how the problems exist even for other physicians when they are patients.

    I'm following the comments closely, in case you haven't noticed. ;)

  3. Let me throw another angle into the mix here. Our medical system, with all the cost cutting and assembly line medicine, has created an atmosphere where the Doctors can not take the time that a patient requires, and often have to "Push them out of the office" to get to the next appointment. This alone can lead to trust being damaged by the patient taking it as a personal affront, and the doctor for not being able to take the time needed to get to know the details of a problem.

    In addition, it seems to be a more common practice for Doctors to look at lab results MORE than looking at the patient right in front of them. They can no longer go by their "Gut reaction", and use the training, and power of observation that they learned, because Insurance does not pay for gut feelings, but need documented facts.

    Yes, the system is broken, but to correct it, let's not make it worse by putting quick fixes and band-aids on it,but rather get to the root of the problems, and address them.

    Creative Ogre

  4. Hi, Creative Ogre. You make a good point. Let me add this to it: improperly done labs. I no longer assume my labs are being done correctly. Do you? For example, when my plasma ACTH is drawn, I know it must be kept on ice, spun within 5 minutes, and then either frozen or tested. Most lab techs do not know this. I have had to read their own manual to them. It's sad.

    I could relate stories about UFC's left to sit on counters for bacteria to ruin the cortisol. Or not allowed to thaw before the aliquot is drawn. Or better yet, not mixing the all the urine if there are two containers for the 24 hours before the aliquot is drawn for testing.

    And more about hemolyzed blood giving improper (and elevated) serum potassium numbers for those of us who were actually hypokalemic.

    What about using the wrong tube altogether for a blood draw.

    Oh, and my favorite, not realizing the lab reference ranges are wrong (I'm thinking late-night/midnight serum cortisols here).

    Why do doctors rely on ONE LAB report? If the numbers don't fit what they see in front of them, then something is wrong. IF they really see the report to begin with. I know in my PCP's office, the nurse only puts it in front of the doctor's face if the numbers are "H" or "L". My PCP, bless her, has learned to look at mine because she knows I'm going to get a copy, too.

    Thanks for the oomment!


  5. Here, here about the test results!

    My initial arginine test (for growth hormone) was incorrectly done. Two years later to error was discovered by my endo. I had been on GH for the 2 years based on those results.

    A retest 2 years ago still showed that I was low on GH so there no problem with me taking the GH - theoretically.

    I turned out to have cancer. Maybe that 2 years on GH caused or contributed to my cancer. I'll probably never know but I sure understand about testing going wrong.



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