A lot of people don’t really trust doctors. Even doctors are skeptical of other doctors. Which is natural, because we have so much knowledge, we can always find a hole in a colleague’s reasoning. This is a good thing overall, because we get together and hammer out the best approach to each individual patient. When it can be a problem, however, is when a physician doesn’t trust his OWN doctor.
I’ve heard a story about a gastroenterologist somewhere along the path of my training. This guy didn’t trust anyone else to do his colonoscopy. A colonoscopy, for those of you who don’t know, is a diagnostic procedure where a doctor shoves a long, narrow tube up your butt. The tube is steerable, and a built-in TV camera allows the doc to examine the walls of your colon, the 5-foot long hollow tube that connects your small intestine to your anus. If the doctor sees any polyps or other weird masses growing on the wall of the colon, he can snip them off and pull them out with the colonoscope. It’s a weird, gross, procedure, but a very important one. Many experts claim that we can essentially wipe out deaths from colon cancer if we do enough of these colonoscopy screenings.
But what’s so weird about this case is that the doctor was so arrogant, or distrustful, or whatever, that he didn’t trust another doctor to do his scope. By the way, the colonoscopy is quite uncomfortable, as you would imagine, so most patients are sedated during the procedure. They typically receive a medication for numbing, and one that makes you sleepy and causes short-term amnesia, which I think is a great idea. I want no memory of a bunch of medical people standing around staring at my fat white butt before they shove a roto-rooter in it.
But this quirky doctor couldn’t receive sedation. He had to be clear headed to do his own colonoscopy. So, he just had to endure the discomfort and memories formed of this procedure.
Speaking of discomfort, what about the physical awkwardness of operating the scope through one’s own anus? It seems that it would be hard to reach, and to control. I’ve helped with a handful of colonoscopies during my training, and it’s not easy. You have to twist and turn, push and pull, steer, and watch closely the whole time. It’s difficult and awkward when it’s in somebody else’s rear end, can you imaging straining to reach your own while operating this machine? This doctor has definite trust issues.
Or maybe he just didn’t want a bunch of people standing around looking at his ass.
I was told early on, but a family doc in Wichita, “Fight the urge to be your own doctor.” I always took that to heart, and went and saw a local doctor for my personal care. But it doesn’t always go well. Each doctor is different, and each has different literature in the forefront of his mind. Here is a personal example:
About three years ago, I was living in western Nebraska. My personal internist took me off my statin, which is a drug used to treat high cholesterol. This in turn is supposed to reduce my risk of having a heart attack or stroke. Great, right? Why would he take me off the drug? Well, he explained, I didn’t have any additional risk factors for arterial disease, such as smoking or diabetes or strong family history. He had been reading a lot of recent research that indicated unknown risks associated with the statins. Things like development of Alzheimers. Also, there are known risk factors, such as damage to the liver and muscles. Live everyone else, I prefer not to take medications if I don’t have to, so I happily agreed.
Then, a few years later, I was living in Kansas and had a new doctor, who took one look at my bloodwork with high cholesterol and prescribed a statin.
I protested, explaining the story about the Nebraska doctor. My new doctor was puzzled, saying that these other risk factors were concerning, and that my risk of having a heart attack with untreated high cholesterol was very significant. He told me, “all the cardiologists I know have themselves on the maximum dose of statins.” The guys who deal with the heart attacks are doing everything possible to not have one.
So, I’m on a statin. Maybe I should talk to the neurologists who treat Alzheimers and see if they are on statins.
Trust for a physician is a funny thing; first of all, about which doctor are we talking? If you mean a patient’s primary care provider, often a family practice specialist, then, sure, lots of people trust their doctors. Sometimes people have seen the same doc for thirty for forty years. That’s a lot of time to get to know somebody, and to build up trust. The history really matters. A small-town doc who took care of you as a kid, then delivered your children and treated their colds and injuries is almost like part of the family.
What about the specialist you just met? The orthopedic surgeon who looked at your knee for thirty seconds then told you to lose weight and take ibuprofen, and get out of his office? This isn’t a guy you’re going to like or to trust. You’re going to find somebody else, or google your symptoms, or go to a chiropractor or an acupuncturist. At least one of these pseudomedical people will be nice to you. They will take your pain seriously and give you some sort of treatment aimed at relieving your suffering.
Specialists aren’t always bad, though. I have seen an orthopedic surgeon for my knee pain, and he was great. I see an allergist for my seasonal allergies, and she’s great. Do I trust them? Sure, I guess. I don’t always do what they recommend, so I suppose that means I don’t trust the specialists that much.
I see patients every day who I have never met before. That’s kind of like the Olympics of earning patient trust. As a radiologist, I see patients with lumps in their breasts, pain, etc. I have to meet someone, earn their trust, educate them on whatever issue we’re dealing with, and offer them a plan. All in three minutes. For the most part it goes pretty well. It’s probably easier for me because I have such a trustworthy face.
It sounds silly, but I know of lots of docs who have been judged immediately by patients based on their appearance. A guy I work with now is in his early forties, but young-looking. He often had patients express concern that he was too young to be a doctor. And of course, there is the problem of sexism. Every female doctor is used to being called, “nurse.” I know this is a problem, but it always kind of tickles my sense of the ridiculous. If patients knew how much smarter and harder working most female doctors are than their male counterparts, they would always demand a female doctor.
What’s the take-home message? I suppose it’s to find a doctor you trust. If you don’t have confidence in someone who is essentially your employee, from the guy who cuts the grass, to the guy who roto-roots out your prostate, you need to find someone else. Choose carefully, and then trust their advice. After all, you need to trust somebody.
Unless you want to do your own colonoscopy.