The 411 on Following the Doctor’s Orders
The personal relationship I had with my former internist is no more. She shuttered her Madison Avenue practice in June of last year and I have been on my own, medically-speaking, since then. I have medical insurance, unlike many less fortunate; but insurance is no longer enough to ensure that I (a) will find an internist who is taking new patients; (b) will be able to replicate the cooperative and respectful relationship I had come to expect from a doctor; or (c) I will respect a new internist enough to be able to follow the doctor’s orders.
This is why I fear the future appears more gloomy. I’ve been unable to find a local internist who accepts new patients and/or my insurance. So I’ve gone to the local Community Health Center until I can find someone. I suffer from high blood pressure. And because many family members do also, I pay attention and monitor mine.
Yet on my first visit to this new doctor, she takes my blood pressure and temperature and very little personal history. My blood pressure is a little high as I tend to suffer from white-coat syndrome, generally— meaning I get anxious and the first reading is always a little high. My former internist would complete her examination and then retake my blood pressure to get a more accurate reading. This new doctor leaves the room only to return to tell me she has called a prescription into the pharmacist to address my blood pressure issue. She is then gone and I am upset.She does not know me and quite possibly she does not know what is best for me, the voice in my head is screaming.
This is a reasonably common description of the relationship between patient and doctors today. A friend who is a doctor confirmed it is roughly 15 minutes in and out. Multiple questions call for a second appointment. This is why I feel it’s imperative that we set our own standards for the 411 on following the doctor’s orders.
In this case, I am not going to follow hers without further input. She does not know me and has not tried to gather my medical history to my satisfaction. Her attitude appears to be ” She knows best. Period.” My attitude is this kind of doctor-patient relationship is passe.
So even though I give some credence to the finding of “a team from Boston Medical Center (BMC) [who] reported in the Journal of General Internal Medicine that among 695 patients studied, those with a low degree of activation (a desire to learn about their disease and an inclination to assume responsibility for their own health) were nearly twice as likely to be readmitted within 30 days than patients more interested in self-care,” there is push back even among those that take responsibility.
I am one of those patients pushing back.
WHY THIS RELATIONSHIP WILL NOT WORK
1. I am accustomed to having more input into my health
I am part of a generation who is accustomed to more cooperation and conversation between the doctor and patient. I expect her to question my lifestyle to determine whether any accommodations can be made. Since I do not have diabetes, I am not eligible to see a nutritionist, which is a little odd to my mind since high blood pressure is a silent killer. But when I ask, she says you can go but insurance will not pay.
I have had 40 years of preventative care history. As a working person my insurance plan was considered a Cadillac plan. My visits to the ER have been limited to an allergic reaction after eating shrimp in a restaurant; a sudden onset of shingles; and a pinched nerve and muscle spasms so bad that only a hospital shot relieved the pain. I am from the school of life where I visited my internist a few times a year for monitoring all aspects of my health even though I was generally healthy. Every report from the GYN to my Optometrist were sent to my internist. She had the most complete oversight of my care and together we consulted with each other, with her in the lead. The new arrangement does not suit my temperament.
2. I believe a combination of traditional medicine and ancient wisdom are a good match
This new doctor quietly returned to the room and stated, “If I were you, I’d take the prescription.” That to me is a veiled threat. Or could it be that the threat is meant as encouragement? Either way it does not work for me. My head goes to a friend’s website, the Empowered Patient, and I think this new proposed relationship is not about empowerment. I am going to seek consul from other resources. There must be a way to mix traditional medicine and ancient wisdom, using food, exercise, lifestyle in some combination.
3. The role of food can never be underestimated if full fledged disease is not my problem
Even though I chose NOT to initially follow this doctor’s prescription, I am fundamentally rejecting this type of relationship. Yet I am having trouble with what is now available to me. I cannot take every pill that is prescribed to me. But I need better resources with whom to consult and rely. Like most patients, I am concerned about taking pills for the rest of my life. Has the rest of my life with pills already started? What role can my diet play in remedying this problem.
HOW FUTURE RELATIONSHIPS WILL LOOK
I am not advocating noncompliance but I am advocating a different kind of patient-doctor relationship. In the foreword to the Future of Health:
Piers Fawkes of PSFK stated:
“Imagine a future where wearable technologies track key areas of your life to provide timely prompts about your health, and the
data gathered can be uploaded securely to the cloud. Instead of going into the doctor’s office for a checkup, you would schedule
a video consultation to discuss your recent readings. In instances when you need further care, your visits would be coordinated
by medical records that flow seamlessly between key members of hospital staff and your care would be supported by relevant
information that prepares you for what’s next. Your surgeon would be able to look at your results alongside the wider patient
population or seek advice from specialists around the world to determine an optimal treatment plan; the effectiveness of which
would determine their compensation.”