Be a Great Patient
It’s an unfortunate fact that a good portion of the practice of medicine involves art rather than science – if it were not for that fact, this particular blog would not need to be written.
Dr. Atul Gawande, a surgeon, writer and professor at the Harvard Medical School wrote in a recent essay, “Just as there is an art to being a doctor, there is an art to being a patient. You must choose wisely when to submit and when to assert yourself.” Far too few do the latter.
Probably one of the best examples of the importance of being a good patient is the subject of prostate cancer. Recent studies have shown a very high prevalence of over-treatment in this often very slowly progressing disease. One study revealed that of a group of men who underwent radical a prostatectomy, half had non-aggressive disease, which probably would have not become symptomatic in their life time. Unfortunately, a high percentage of those who underwent these unneeded procedures were relegated to needlessly live with unpleasant side effects such as incontinence and erectile dysfunction.
A great example of being an informed, involved patient is Ralph Blum, the co-author of the book on prostate cancer entitled, “The Prostate Snatchers.” Here is how Mr. Blum describes his experience:
“My own experience with urologists has not been a happy one. Twenty years ago, a doctor who wanted nothing but patient compliance, told me that if I did not agree to immediate surgery I would be dead in two years. His recommendation and prognosis were not only wrong, but in my opinion violated the ancient medical precept incorporated in the Hippocratic Oath: “First do no harm.” Fortunately I was not the kind of patient to be easily intimidated.”
Twenty years later, Mr. Blum still has his prostate gland and is not suffering the side effects of needless surgery.
Another illustration of being a good patient is illustrated in a book that I read last year entitled, “Prostate Cancer Breakthroughs, A Step-By-Step Guide to Cutting-Edge Diagnostic Tests and 8 Medically-Proven Treatments.” The book was written by Jay S. Cohen, M.D. who was diagnosed with prostate cancer and resisted his urologist’s recommendation to undergo a radical prostatectomy. He went into intense research mode, ferreted out the latest and greatest developments in the field of prostate cancer, and was able to deal with his cancer sans surgical intervention. The book is a must read for anyone interested in the subject.
Finally on a personal note, I broke my neck towards the end of 2005 – it was a fracture of the C1 cervical vertebrae, the rarest and statistically most fatal of neck fractures. When there was no sign of healing after two months, my board-certified spinal surgeon informed me that if I did not undergo surgery to fuse my C1 to either the occiput (base of the skull) or C2, I was in mortal danger in that even a minor fall could lead to death. He further informed me that the surgery would leave me with a permanent minimum loss of 50% of my neck mobility. As an active person/athlete, I was not about to submit to that prognosis and I went into intense research mode, which ultimately led me to a spinal surgeon that shepherded me through the recovery process without surgery. Here is how I looked in the emergency room the day I broke my neck:
And here is how I looked yesterday when I took this selfie:
I would not have been able to do the necessary work to look like that at the age of 74 with a fused neck!
What’s the take away? Be your own medical advocate. Do your own research – something that is so easily accomplished on the Internet. Look into support groups for whatever medical issue you might be dealing with. Empower yourself to say “NO.” to your physician. Unfortunately, the medical profession has attained a position of reverence in our society. A friend of mine recently diagnosed with prostate cancer, balked at my recommendation for a second opinion stating that he was afraid his physician would react negatively to his seeking a second opinion. Any physician worth his medical degree should encourage multiple opinions regarding important, potentially life changing medical procedures.
Remember, in the end it is YOU, not your physician, who will live with the consequences of your medical decisions. Become a great patient!