One of my oft-quoted bloggers is Dr. Rob Lamberts, a primary care physician who blogs regularly on topics of interest to patients and professionals. Recently he posted A Letter to Patients with Chronic Disease which triggered a storm of comments - worth sharing with you.
The basis for his letter is this: Doctors are normal, fallible people. Doctors choose doctoring as a profession because they want to fix people. When they can't fix someone, it upsets them. and when it comes to patients with a chronic disease, as explained by Dr. Rob himself:
But chronic unsolvable disease stands square in our way. You don't get better, and it makes many of us frustrated, and it makes some of us mad at you. We don't want to face things we can't fix because it shows our limits. We want the miraculous, and you deny us that chance.
Dr. Rob goes on to provide advice for chronic disease patients to help them smooth the road as they deal with their doctors. His advice includes everything from "Don't come on too strong," to "Forgive us," and a number of ideas in between.
Regular readers of this blog know that I'm not a fan of doctors telling us patients what to do. I've likened their advice to the fox-doctors giving us chicken-patients advice about behaving in the hen house. Too often there are conflicts of interest which set up the doctor to provide advice that simply makes life easier for him or her, but doesn't necessarily help patients.
However, I'll temper my own opinions for this piece from Dr. Rob. While I don't think he covers every problem chronic disease patients encounter in his post (for example - he doesn't acknowledge that one MAJOR problem is that patients can't get enough time with their doctors because their payers won't allow it), I do think he provides an excellent starting place for chronic disease patients. If you understand and act on what he has to say, it may improve the care you get.
However - I (thankfully) don't have a chronic disease, so I don't feel I can represent the point of view of those who do, anymore than Dr. Rob can. So I ask you -- how did Dr. Rob do?
A Letter to Patients with Chronic Disease
Did he mostly get it right? Do you agree or disagree? Have something to add? Or -- subtract? Does your doctor understand as well as Dr. Rob? Or?
What advice or best practices have you - as a patient with a chronic disease - developed for working with your doctors? Please share in the comments section below.
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Read previous posts quoting Dr. Rob:
• Does Technology Make Your Doctor Sweat?
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Photo © Microsoft Image Gallery (Why a llama? Ask Dr. Rob!)
I was truly touched by Dr. Rob’s article Trisha. I had never considered that chronically ill patients scare doctors. This was my first experience with his work and I am very impressed with his perspective.
I see my job as helping patients and their provider’s speak the same language. I am not a physician and communication is a two way street. It’s really important for my clients that I understand patient provider communication from both perspectives.
I wrote my reflections on my blog – http://tinyurl.com/2en9za6
I’m thrilled that, as always, you bring up such important stuff to your readers to help us reflect thoughtfully on the realities of patient provider communications. Thank you for sharing this.
Dr. Rob gets it right when he explains why doctors get frustrated with things they can’t fix. Don’t we all?
But that’s beside the point. Blaming patients for chronic illness, even if some facet of it is their fault, is time wasted. Doctors talk about “non compliant” patients all the time. Chronic bitching. The reason doctors are frustrated is because they still think that they have power and that they “give orders”. The notion that patients are inclined or obligated to follow orders is absurd and the root cause of all their frustration. If physicians would alter their outlook to understand that they convey information and give recommendations but they have no power, they could improve their attitudes.
There is no such thing as a non compliant patient only one who didn’t speak up and say “I don’t agree with you” or “I don’t intend to follow your recommendations”. Patients are bullied by doctors to listen and shut up. The internal unspoken mantra of the patient…..”you’re not the boss of me”.
When doctors start interacting with patients as adults, not as ignorant difficult children, and start sharing medical treatment decisions with patients then the patient’s health can improve and so can the doctors frustration. Lose your contempt….lose your frustration.
Sorry Dr. Rob. Your frustration is a problem of your own making. Physician heal thyself.
I’ve already commented at length in response to Dr. Rob on this particular blog entry and on his follow-up at The Healthcare Blog. In the original, his exhortation to patients to “not come on too strong” was perhaps the one that bugged me the most. Generally, I agree with Trisha, but “don’t come on too strong”? Really, that concept has to be tempered. Anyone can “come on too strong.” I’ve had doctors that came on pretty strong with the whole patriarchal power trip. My favorite: the Doc hands you a nearly indecipherable sheet of paper, covered with blocks full of medical abbreviations, and the doctor says, “We’re going to get some labs.” They don’t say what the tests are, what they’re for, why they’re necessary. When you get to the lab, you don’t know whether they’re going to take blood, urine, or both. You don’t even know what’s being tested. I remember one doctor, my ex-wife’s, who bristled when I asked what he was testing. He answered, “It’s complicated.”
Doc Rob sounds like a really nice guy. Some doctors aren’t really nice guys. I find out by talking to them. If they insist on monopolizing the conversation, won’t answer questions, attempt to patronize me, seem to have no sense of sympathy, call for expensive tests without even mentioning that they’re expensive, I press a little harder (I think everyone deserves a second chance, and these guys are overworked). If they persist, I find another doctor. With co-pays now at $30 ($35 per visit with specialists), I can’t afford to go through two visits before deciding I need a different doctor.
I posted something thinking it was as a “guest” and it left my entire name. I am appalled by this. Please delete my post and my name.