medical side effects

My Unsolicited Medical Advice
May 8th, 2012

I suppose I have an unusually large portion of my identity staked in being healthy.  I sort of pride myself on it – on not missing checkups, never having had a cavity, exercising regularly, having a cholesterol ratio of 2:1, eating lots of broccoli, and drinking lots of water.  I’m in this thing for the long haul and I want my body to go the distance.  When it comes to being healthy, I think I’m reasonably good at it.

In addition to my healthy lifestyle obsession I have a bit of knowledge about the healthcare industry.  I used to work for a healthcare company, and still have many friends and former colleagues in that industry.  I am also fascinated by the writings of people like Atul Gawande and their insights into how we practice and consume medical care in this country.

Given these two little truths about me, I was particularly struck by an article I read in a magazine at the gym last weekend.  It was Glamour, or Elle, or something along those lines – something decidedly non-medical.  (It was whichever rag had Rachel McAdams on the cover of its February issue…)  At any rate, the article contained letters from doctors.  The letters were to anonymous patients and said what these doctors “really wanted to say” to their patients.  Apparently – and I suppose this shouldn’t surprise me although I wish it did – many doctors withhold the full scope of their concerns about the health ramifications of patients’ lifestyle choices for fear of appearing judgmental.  So in these letters they let it all spill forth.  And it was heartbreaking.

Why don’t doctors tell us the truth?  For those of us in good health, we are lucky that there aren’t many painful truths to be told.  But for people who need to be confronted, are doctors not holding up their end of the bargain when they soft-pedal their concerns?  I’m all for physician diplomacy and happy patient relationships.  But I’m also fairly sure that there’s some interpretation of the Hippocratic oath that is violated when our doctors are legitimately worried about us and keep it to themselves.

With that – and my moderate knowledge of the healthcare industry – in mind, I thought I might offer my own perspective on what I look for in a doctor.

Asking Questions

Does your doctor ask you questions about how you maintain your health?  Are they open-ended?  Does she ask, “Do you exercise regularly?”  Or does she ask, “What is your current exercise routine?”  For starters, the Yes/No version makes it a lot easier to lie.  Secondly, the open-ended version starts a dialog.  This is true of discussions of diet and exercise, but also medications, pain points, stress levels, and myriad other concerns.  Doctors who hear you out will be operating from a place of much more complete information, and their advice and guidance will likely in turn be much more complete.

Basic History

What does your doctor know about you?  Does he know more than what you entered on the health history checklist at your first appointment?  If you have switched doctors get your records released from your old doctor and have them sent to your new one in advance of your first visit.  When you go to your first appointment ask your doctor if he’s read the records you sent over.  If not, find out why and determine if you’re in the right person’s care.

Touching

Does your doctor touch you when you go in for a checkup?  Or is he just looking at lab results and other statistics on paper.  Does he feel your lymph nodes and listen to your heart?  Does he ask questions when he checks you?  Is he paying close attention to his exam or is he just going through the motions?

Incentives

This is a big one.  And, honestly, it’s not one that you have much control over.  Nevertheless, it’s good to be aware of your physician’s incentives.  Most doctors are still paid by hospitals and insurance companies on a fee-for-service basis.  This means that they are paid a fixed amount for each exam/procedure that they perform.  In short, it’s volume-based and more patients seen means more money earned.  Internists are paid the same amount of money for a thorough checkup as a slapdash one.  Surgeons are paid the same amount for a smooth and precise surgery as one riddled with complications and errors.  I’m sure you can imagine (or have likely experienced for yourself) what this looks like in practice.  The good news is that there is a slowly-emerging trend in healthcare toward “accountable care.”  This means that physicians are in some way held accountable for their performance, whether via taking on financial risk for the health of their patients, or via bonus payments for providing high quality care.  My advice on this one?  Ask your doctor how she gets paid. Even if she’s still on a fee-for-service model merely asking the question will alert her to the fact that you are an informed patient and will be paying attention to the attention she pays to you.

So there you have it.  Gale’s guide to health and wellness.  I have no idea what any actual medical professional would think about it, but it works for me.  And maybe it will work for you.

3 Responses to “My Unsolicited Medical Advice”

  1. Kathryn at Good Life Road Says:

    I can relate to this Gale, in that we have a cousin our same age who is obese. It’s very difficult to skate that line between opening up a very important dialogue that could save her life or just being polite. Even though we are obviously not her health care providers I feel a sense of responsibility toward the people I love to give them the best from me and just walking around a subject that will ultimately kill her if she doesn’t face it feels wrong. Having many doctors and nurses in my family, I know that you can not wait for your unrelated-to-you doctor to give you much more than the necessary and acute advice. I think there is some responsibility on the part of friends and loved ones to be gentle but as helpful as they are able when it comes to the really important subjects in life and nothing could be more important than your health. Nice post!

  2. BigLittleWolf Says:

    This is such an important topic, Gale – and the discussion is vast. I’ve written a bit on this myself, as a “consumer” of very spotty healthcare services (sometimes excellent, sometimes dreadful, other times nonexistent).

    I have also noted a surprising lack of touch, an equally surprising absence of questions, and an unwillingness to listen to a patient’s questions or description of issues.

    There are often assumptions made based on the patient’s age, sex, and marital status. In other words, 40+ and female, and also divorced? Everything is chalked up to depression, whether you’re depressed or not!

    Financial issues?

    Same thing.

    Female, not married, 50, and in a GYN office? There is all too often an assumption that you are not sexually active and there is no discussion of the related health issues.

    I find it all ridiculous, but prefer to think of it as “plenty of room for improvement.”

    Wonderful post!

  3. Gale Says:

    Kathryn – Thanks for shedding additional light on this topic. You make a great point about friends and family members of people with unhealthy habits. It can be so tricky to raise these issues without seeming to cast judgment. Conditions like obesity are so stigmatized that it’s a real challenge to express concern without it being taken the wrong way. I like to believe that doctors have it a bit easier as they are speaking as an unbiased influencer and an expert in the field, but apparently they face the same reluctance that most of the rest of us do. It’s a shame.