Understanding—and dealing with—the medical mind

by Jenny on January 26, 2012

I recently received an email from an organization that focuses on encouraging patients to consider filing for malpractice if something goes “wrong” with their treatment by someone in the medical field. They wanted me to provide a link on my site to theirs, but my instinctive response is a rather resounding “no!”

My reasoning isn’t that true malpractice doesn’t sometimes occur. Rather, I think it’s possible to make a case that the perceived threat of a lawsuit can cause at least as many, if not more, problems than does poor medical treatment itself. That last thought is the focus of this post.

There is clear evidence(1) that the enormous stress on a physician brought about by a malpractice suit frequently leads to depression and burnout and even thoughts of suicide. For the patient, her or his physician’s stress of a malpractice suit often leads to over-testing, over-medicating, unnecessary surgeries (especially exploratory and biopsies) and over-reliance on test results and technology instead of the patient’s history or the physician’s understanding of a particular patient. The experience of a malpractice suit can even lead to a physician refusing to take some cases. I wouldn’t be surprised if just the perceived threat of a malpractice suit can lead to the same types of over-cautious actions.

A physician’s stress and burnout and over-reliance on technology to try to protect him- or herself not only results in the potential for more errors but quite likely results in less interest in patients—after all, they might sue—which leads to a less personal relationship with the patient as a person. And, of course, a patient who is treated impersonally is more likely to feel alienated from the physician and is therefore more likely to sue.

It’s a vicious circle, but one that potentially can be avoided or escaped, and often the patient needs to take the initiative. Based on various sources—including my own experience with Western medicine—here are some of my thoughts on how you might work more effectively with your doctor:

  • Engage your physician as your partner. Be up-front with your doctor about your values, concerns, goals, etc., and be sure he or she really hears you.
  • Avoid being adversarial. Be polite and respectful. Treat your doctor as your ally, not your enemy, and she or he will respond accordingly. It is often helpful to openly acknowledge to your doctor how you think she or he views you. For example you might say “You probably see me as argumentative and stubborn, but . . . .”
  • Be an active participant in your care. Question what your doctor says, but politely, to be sure you fully understand what he or she is telling you. Ask the doctor to explain your disorder and the treatment options in lay terms and repeat them back to be sure you fully understand what is being said to you, and write everything down for later reference. In fact you may want to bring a family member or friend with you to an appointment so you don’t miss something important.
  • Don’t hesitate to look up everything on the Internet to clarify your understanding. In addition, you might want to get a second or even a third opinion, depending on your problem. A good doctor will respect you for being thorough.
  • Although there is a perception that Western medicine can work miracles, the costs of some tests and treatments—and not just in monetary terms—may be higher than you would like to pay, so ask for details, especially including the potential outcomes (positive and negative, and the probabilities of each) of a procedure or the expected benefits and side effects from possible medications. Ask how other patients of your doctor have fared under the same treatment. A highly touted cancer therapy might give you an extra few months of life, but those few extra weeks may be at the expense of your quality of life.
  • If you engage your doctor in a candid dialog, you might be surprised that she or he agrees with your misgivings. Not all doctors think that the most aggressive treatment is necessarily the best option(2).
  • Consult with close family and friends, as well as your doctor (or doctors), to be sure you are all on the same page. If necessary, change doctors.
  • Look into CAM (complementary and alternative medicine) therapies to see how they might complement—or even replace (if that is your inclination)—the Western options that are available to you. But get a firm diagnosis first, since your CAM providers need to be clear about what they are treating you for and, by law, they cannot offer you a diagnosis.

Two final points:

  • When you have done all your homework, the final decision about what you do and do not want to do needs to be made by you.
  • And always remember, your doctor is a person, too(3)!

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References:

1.   Chen, Pauline W., MD: “When the Doctor Faces a Lawsuit” New York Times, December 15, 2011. http://well.blogs.nytimes.com/2011/12/15/when-the-doctor-gets-sued-2/?ref=malpractice

2.   Murray, Ken, MD: “How Doctors Die.” http://zocalopublicsquare.org/thepublicsquare/2011/11/30/how-doctors-die/read/nexus/)

3.   Groopman, Jerome, MD:  How Doctors Think by Jerome Groopman, MD (Houghton Mifflin Co., © 2007).

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Patient-centered health care

by Jenny on January 6, 2012

After writing my first post describing my goals for this blog I did some thinking about how to really begin, and it’s clear that there is only one place to start: with the individual who is at the core of the whole healthcare system, the one without whom there would be no healthcare system. In other words, I want to begin with the patient.

Just out of curiosity I looked up the word “patient” in my American Heritage Dictionary and discovered that it comes from a Middle English word that means “one who suffers.”  Its Latin root means “to endure.” The first definition of the word in its adjectival form is “Bearing or enduring pain, difficulty, provocation, or annoyance with calmness.” I bet those definitions resonate with at least some of your dealings with the Western healthcare system. I know they reflect some of my own experiences.

One of the current trends in Western medicine is “patient-centered health care,” so the industry is beginning to recognize the problem with how patients are frequently treated. If you’ll pardon a little irony, health care can be (and often is) insurance-centered, medical staff (especially MD)-centered, hospital- or medical center-centered, pharmaceutical-centered, medical equipment-centered, test- and lab work-centered, procedure-centered, paperwork-centered and, of course, (encompassing the others), money-centered. As for the patient, the spotlight is generally on a disease or disorder of some sort or on an organ. Whatever the focus, too often it is not on the whole person—the unique living being who includes not only organs in a physical body but also a mind, emotions, spirit, culture, age, gender, community, etc.—who is asking for help.

I do want to acknowledge that there are a significant number of physicians and health care centers that already practice true care of the person, and they deserve accolades. But for the rest, there is definitely still work to be done. The current focus on patient-centered care is a very hopeful sign. I did a quick on-line search of “patient-centered health care” and found references to research on bringing patients around to the medical community’s views on their care, and on whether patient-centered health care is necessary and whether patients even want it, but not much on what the phrase really means except for some rather terse definitions. (See http://www.patientsorganizations.org/attach.pl/547/494/IAPO%20Patient-Centred%20Healthcare%20Review%202nd%20edition.pdf for a good overview of current research.) What seems to me to be still missing in much of the discussion of this topic is focus on the patient as an individual.

I believe that patient-centered health care is actually an old, not a new, idea. It was practiced by the old country doctor who knew his “patients” personally, made house calls, and was available at any time. It is practiced by healers in native cultures. And it is frequently practiced by contemporary holistic healers, those who provide what are known as complementary and alternative modalities (CAM), both old and new, such as massage, homeopathy, chiropractic, herbalism, Ayurveda, acupuncture, hypnotherapy, and bio-energy modalities like Reiki.

In my view, these healers nearly always care for each person who comes to them as a unique and whole person. They don’t provide one-size-fits-all medicine. These healers engage the people who come to them as partners in healing by actually listening to them and really seeing them as individuals. These practitioners are frequently truly holistic, actively including, rather than shying away from, the mental, emotional, spiritual, and cultural aspects of their clients.

So based on all of this, here’s my own definition of what a patient-centered health care provider would look like:  Someone who cares about, listens to, and addresses (using understandable English or the person’s native language) the whole person as a unique individual and tailors health options accordingly, either supplied by the health care provider or through referrals, including modalities that are usually considered to be CAM or even indigenous, with the person as a full partner in any decisions about his or her care.

This definition sounds very simple to implement, and it should be, at least in theory.  But there are many factors that are interfering with the easy adoption of this approach—on the side of the prevailing philosophy of Western medicine but also on the part of the patient—and I’ll leave those for future posts.

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New blog, new goals

December 21, 2011

In the last incarnation of my website I created a set of occasional blogs primarily focused on personal healing that (I confess) were usually very thinly disguised ads for my services. Although I will most likely rewrite and repost some of that material along the way (without the blatant ads), my goals for this version [...]

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