Six Seeds of the Pomegranate

After nearly a year’s dithering hiatus, talk of MDs on the NY Times has driven me back here. Well, better late than never, as the kids say.

This is the provoking article: Are Patients in Part to Blame When Doctors Miss the Diagnosis?
Discussion here: Well: Who’s to Blame for a Missed Diagnosis?

The thing that bothers me here is actually a throwaway line:

It turned out that Marla was like my mother, a preventive health and alternative medicine enthusiast. …Two years earlier, Marla had noticed a pebble-sized lump in her left breast. Her primary care physician scheduled her for a mammogram, but Marla wanted first to try alternative remedies, so she skipped the appointment. She never went back to see her doctor because she felt that as soon as she began talking about other treatment options, he “shut down.”

The writer, who is of course a doctor, then goes on to deplore the various personal and systematic causes that contribute to missed diagnoses. The gist of the piece seems to be that doctors maybe sometimes make mistakes but aren’t responsible for patient stupidity or laxity. But it fails to consider legitimate reasons patients might not schedule follow-up care, many of which are later raised in the blog post comments — factors like cost, scheduling, job security, family responsibilities, fear, and (real or perceived) disrespect from the physician in question. While the others are more practical and logistical issues, the last is the most difficult to quantify and maintain.

Respect is important. Yeah, trite self-help book statement alert!, but a lot of people lose sight of this very simple fact (or maybe my exposure to the stockbroker/lawyer zone of the Loop has skewed my perception). And respect seems to be lacking in a lot of doctor-patient interactions. Marla’s original doctor refused to even consider alternate care options; he or she couldn’t even be bothered to hear about them from Marla or weigh her concerns about medical science. (Before you make too many assumptions, note that Marla clearly had SOME faith in medical treatment, or she wouldn’t have been visited a doctor at all. So don’t climb up on that “homeopathy is a total crock, medical science FTW” high horse just yet.) I think what Marla really needed, more than herbal remedies or surgery, was respect, and this point, which jumped out at me (and a lot of the commenters) was just kind of skimmed over by Dr. Chen. She doesn’t pause to consider the intangible way this patronizing dismissal influenced the patient’s decision about future care. Granted, Marla clearly shouldn’t have skipped out on that mammogram; but she might have been more receptive to the idea if the doc’s response ran more along the lines of “Well, why don’t we confirm what’s going on here, and then I’ll give you information on chemo/surgery/radiation and I’ll look into the alternative remedies you want to try” instead of “Just get the mammogram, you crazy dumb hippie.”

The best experience I ever had with a doctor was with a gynecologist I saw a few months ago; it was my first interaction with a doctor who listened to me. That’s not to say she didn’t correct me on some points or clarify some others, but she treated me like a whole person instead of a walking medical history to be drugged into medical homogeneity. She answered my questions and explained all the things my previous doctor couldn’t be bothered to. And when I told her the medication the last doctor prescribed caused a very unpleasant reaction, she suggested — gasp! — a natural remedy, which worked beautifully AND without any side effects.

I think a lot of doctors don’t realize how offensive it is to just dismiss a patient’s suggestions and concerns, carried along by that “doctor knows best” arrogance. As a patient I have the right to an explanation — why should I fill a scrip or submit to an invasive/painful/expensive test without a good reason? Yes, you have years of highly specialized medical training and experience. That’s why you’re wearing the lab coat and I’m huddled in this drafty gown. But this is my body. I’ve been living in it my whole life. We’re both fallible human beings here — it’s hard to argue that one of us is more fallible than the other. I’ll admit to the possibility of a mistake if you will.

Why, no, I don’t entirely trust the medical establishment. But that’s another post entirely. If I had it in me that might be a whole ‘nother blog.