The Point of it all
My niece Emma said something profound to me about the doctor - patient relationship. We were talking about the state of healthcare today on the way back from the airport. She said "The doctor sees me 2-3X a year for 15-30 minutes, I live in my body all year. I know when something is not right. Why do I have to hear, either it's nothing or let's wait and see if it changes." It is a problem for medicine these days. Patients do not feel heard. Visits are generally focused on a specific symptom and the chit chat has left the room. It is a challenge for the medical profession as well as the patient.
My niece's point was she wanted to be heard. She wanted the doctor to respect her and what her body was telling her. I have found patients often pick up the signs of trouble first and these symptoms can be vague. Unfortunately, medical professionals are often restricted by insurance guidelines for ordering tests and the politically correct thinking of evidence based medicine. Evidence medicine is a funny concept to me and like the emperor's new clothes. Since when has medicine not been evidence based. I understand it was started as a reaction to the over use of antibiotics but it has become a restrictive and conservative basis for medical decision making. It is not designed to listen to the patient. If the patient's symptoms do not fit in the box then it must be psychological. Once it is deemed not medical, then the patient is not given any more time. Sometimes, it is nothing but if a patient returns with continued symptoms, then it is time to listen.
Sometimes, thinking outside the evidence based box is essential. In the early days of HIV/AIDS medicine, if we hadn't been creative and thoughtful, our clients would have suffered even more. If there was a hint that something could work, we were willing to try it. Our patients comfort and well being was paramount in our work.
I'd like to think medical professionals do listen but as an advocate, I receive many calls, asking for help finding another practitioner because symptoms were worsening or asking me how to get someone to listen. People know it isn't in their head and the symptoms are real. Sometimes, a new doctor or one test can clarify everything. I had a client who had a shoulder problem. The orthopedic doctor refused an MRI after PT was unsuccessful. I told her to have the primary care order it. She had a rotator cuff injury. She got a new doctor.
I understand that in this litigious world, many tests are ordered that don't need to be. It is a dilemma in medicine whether to order or wait, whether the patient's concerns are genuine or is this person in need of counseling? I sympathize and remember being in that position myself. Whether the symptoms are real or not to you, they are real to the patient and they need to be heard.
Posted by HealthCare Whisperer at 6/4/2010 12:51 PM 
Categories: medical doctor, evidence based
Tags: medical doctor evidence based
Categories: medical doctor, evidence based
Tags: medical doctor evidence based
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