Over the years, I’ve come to realize that the doctor-patient relationship is vital to good health. As with any other relationship, it must be built on effective and clear communication, understanding, compassion, and just mutual “liking.”
Unfortunately, it’s hard to find a really satisfying doctor relationship. It’s hard enough to find friends out in the wide world of people, to find someone who just clicks, who is fun and understanding and supportive. When you’re narrowing down the pool of potential medical mates to perhaps 50 people in your town who are qualified and approved by your insurance, then finding that kind of chemistry in that small group is going to be a real challenge. And it’s not as if those 50 potential mates are sitting in one room, giving you an afternoon to interview them and get to know them. They’re holed up in an office somewhere, with crazy schedules, spending 5 minutes with each of their already existing patients, and walled in by receptionists who take messages and aren’t necessarily great conduits for starting relationships or even investigating the possibility.
So I don’t really expect my doctor relationship to be as close and mutually satisfying as a great friendship. But it still must have a few of those qualities for it to be most effective.
Here’s the thing: I know my body best. I’m not a doctor; I don’t have medical training. But I’m not completely ignorant when it comes to medical issues; perhaps that makes me one of those frustrating patients who knows just enough to make me dangerous. Perhaps it’s helpful. At any rate, that’s where I am. I do know that I’ve been in charge of my own medical care for 20-plus years, and I’ve taken all kinds of medications over the years, seen a number of doctors and some specialists, had some tests, and had a LOT of time to ponder on test results or effects of what I’ve taken or tried. I’ve been smack dab in the middle of my own personal lab experiment for all this time. I’ve said for some time now that it’s really unfortunate that I don’t have my own control group. That would make things so much easier. But I’m one person and I’m the control group and the experimental group in one. It doesn’t make for good experimenting. But that’s how it is.
I know these things: over the years, I have come to appreciate that any hormonal changes in my body really reverberate and effect my whole being, emotionally and physically. Female hormone changes can make me irritable or emotional; they can make me tired; they can make me bloated, and they can make all kinds of other waves I don’t even register in my consciousness. I know that I have a mental illness that requires medication, and that is also a very delicate state of being, to get to where medication helps me but doesn’t knock me out or make me feel numb emotionally. I know that if I don’t feel “right,” then I should look into whatever options there are.
Unfortunately, again, since I’m not medically trained, and I don’t have authority to write prescriptions for myself, I need a trained doctor to step in and work with me to find possible problems and possible solutions. We need to be a team. I will respect your training and experience, but I need you to respect that I can feel things in my gut about myself that you can’t. We don’t have a few hours for me to use all the words that it might take to express why I might feel something particular just “in my gut.” I have to figure out how to get it across in about two minutes. And if I can’t do that, then we’re stuck.
I know if I’ve gained weight. You don’t need to point it out. Believe me, I’m all too aware of it. And if you’re a petite woman who runs marathons and doesn’t have a problem with overeating, then I’m going to instantly feel that you won’t understand where I’m coming from, unless you put me at ease otherwise and try not to judge. I eat healthy, mostly, and I exercise every day. I’m doing the best I can. Pointing out I’ve gained 20 pounds and sighing and shaking your head won’t make me feel any more motivated. It will only depress me. Not only that, it will make me dread having to come in and see you. That’s never good. If I dread coming in to your office, then I’ll put it off, and everyone knows that putting off important medical care is bad. Plus, being anxious anticipating what you’re going to say will probably elevate my blood pressure readings while I’m in the office.
If I tell you I’d like to consider some alternate therapies or tests that you don’t usually use, I’d like your support. Sometimes, those require your signatures and authorization. Please don’t refuse because you think these things are a waste of time or money. If I feel that there’s something going on that your regular tests and medicines don’t seem to be addressing, I’d like the opportunity to waste my own time or money. At least I’ll know I’ve tried. I’m not way out there trying really bizarre things. So try to have a little bit of open-mindedness. Yes, I know where you’re coming from. But please understand how frustrating it is to feel “not right” and not have any answers. Rather than making a face and flat-out refusing, you could at least explore more why I’d like to try something else and perhaps find a way within traditional medicine to address that issue. You support my going to an acupuncturist. So let me try a compounding pharmacist, for example. But the second you squeeze up your face into a disapproving look and shake your head and refuse, you’re going to earn my ire (anyone who knows me would know that will just set me off). At least try to make me feel that you’ve heard my concerns and figure out a way to address them your way; at least make me feel that I’m an active partner in my own care. Don’t make me feel judged or condescended to or brushed aside. Work with me so I can feel validated and part of the team.
Listen, I understand that working in health care is tough these days. Doctors especially have huge debts from medical school and have to jump through all kinds of hoops just to get reimbursed halfway reasonable amounts for the work they do. Yeah, it stinks. I appreciate that. My husband works in health care, though he’s not a primary physician. So I’m not completely ignorant. I understand that you need to be true to the science you were taught that was thoroughly researched. But you have to appreciate also that the knowledge we do have is still pretty limited, and that a lot of research that has been done either used men exclusively as the experimental group, or averages have been calculated using the data from a variety of people. We also know that some research ends up being faulty or rushed and has to be reversed later on, with great human costs. Don’t blame me for being just a little bit skeptical sometimes. And simply averaging information gathered from groups of subjects and mathematically deciding that data then should apply exactly to my individual body chemistry and internal workings is not what I’d call the most effective use of scientific inquiry, either.
Most of all, please understand that how I feel is not just physical symptoms, but emotional. It’s all part of one big whole. If I try to take a few minutes to explain or ask for further help or thinking out of the box, please indulge me if you possibly can. If I don’t feel you’re hearing or understanding me, I’ll get more emotional. It’s natural. Don’t blame it on my “being mentally ill” or think immediately that I must need a higher dose of medication for my mental illness. “Normal” people have a wide range of how they express and show emotions, and it’s natural to feel frustrated when we feel we’re not being heard. It’s natural to feel emotional if you don’t feel well physically and there doesn’t seem to be an obvious reason. Please validate my feelings rather than telling me that I don’t have the right to express them in any way. I work hard to be kind and civil and understanding, but I am not devoid of emotion, and I cannot stay completely poker-faced when I feel frustrated. Don’t write me off. But when you say we may not be a good fit, you know what, you’re right about that. But sometimes we patients don’t have the luxury of finding a great fit. I just have to make do with that little group of doctors in town that my insurance will pay for and who are taking new patients. But if you know another doctor who might be a good fit for me, then by all means, please give me a name.
I would very much like to find a doctor who will be on the same wavelength with me, at least in how I communicate with words and body language and a little show of emotion. I’d like one who maybe even has a little sense of humor or likes to banter a little. Maybe with the way our health care system works today, that might be impossible to ask for both of us. If that’s the case, that’s very sad. And on a political note, if that is the case, then just making our health care system bigger won’t solve the problem. It needs an overhaul; it at least needs tweaking and adjusting. Let’s not just make a really ineffective system bigger so more people can be frustrated. Let’s dig into it and see how to truly make it BETTER.
Thanks for your time, former doctor and potential new doctor. I know you have a tough job to do. Thanks for going to medical school and doing the work you do. I just hope that we as a society can figure out how to do better in matching patients to doctors so this process of finding optimal health can be a little easier.