Doctors Notes
By Michael B. Teiger, MD, FCCP
The ‘NEED TO DO’ in Medical Care
I
was in a fairly big rush that day. As usual, I start the day with hospital rounds, but on that particular morning there were many more patients to see. So, I was late to get to my main office, arriving in the midmorning. I noted the patients sched- uled to be seen before I would have to return to my car and drive to my satellite office, a half an hour away in a neighboring suburb town. While this was a fairly busy day, the process was something I was used to as it had become my routine, ingrained in my lifestyle over the past 25 years. So, when the final patient of the morning arrived at my main office, I must admit I was rushed and eager to begin the drive to my satellite office. I also admit that when I realized this was a new patient who would need new patient intake information, I was a little bit irritated at having to spend the extra time. But, I expected the interview and necessary paperwork to be quick, so I could be off to my next destination in due time. The interview however did not go as expected, through no fault of the patient. In fact, the pace of my discussion with her naturally but dramatically slowed when I heard her story. I needed to listen carefully to what she had to say. She was referred to me by another physician in the com- munity because I am a specialist in pulmonary diseases and this lady was having difficulty controlling her asthma. I heard her story of difficulty with control over several years. I heard her daily struggles, especially during allergy seasons and took a careful inventory of the list of all the medications she had been prescribed throughout the years. What struck me as profoundly important was that, in general, she did not like to take any prescription medications, and although she accumulated many medications from her physician, she had not been taking them. She was simply afraid of the medication side effects and com- plications, especially after reading the complications published on the internet. In fact, she also admitted to being a little bit afraid of admitting her noncompliance to her physician and just struggled along with her respiratory difficulty. What was most curious to me was that she admitted this, in fact, and still liked and respected this referring physician. She just did not want to do as she had been told. I was thoroughly taken aback by her story. I reflected on the disconnect between this patient and her primary doctor. The amount of trust that existed between the patient and her physi- cian was very low; yet, she clearly wanted to do well by her caregiver and was as receptive as she was able. She had many misgivings and many concerns, and she has a right to her feel-
28 Essential Living Maine ~ June 2014
ings and opinions, but there was a clear lack of communication and understanding between her and her doctor. Perhaps this relationship is where the healing begins. In my experience as a pulmonary and critical care physician dedicated entirely to clinical care, I acknowledge that this is not an isolated episode. This story is really all too common. As a doc who is referred patients from other docs, I often have these types of conversations with patients. Admittedly, there are many, many patients who go to physicians with problems and have the expectation of receiving a cure through a pill. This is a com- mon medical expectation in America. However, there are just as many patients who are more interested in receiving information, talking about their problems, and who would like help under- standing their condition. The latter group of patients does not necessarily want a prescription, but often, they get prescriptions nonetheless. There is something very basic to the understanding of
Western, traditional medical care that is practiced in America. We physicians who are trained in American medical schools are taught to think in terms of problem orientation. The simple real- ity is that when patients come to our office with complaints, we respond by attacking the problem. We are taught that the tools we have to offer are, in almost all cases, either drugs or surgical treatment. Occasionally, we recommend physical therapy for orthopedic problems. But, by and large, we are very much a pill oriented society. This is nothing new and has been a concept covered in news media and in publications in great detail. And, in fact, doctors respond to the expectations of those patients which are almost always an expectation of “the cure” to the malady that affects them because this is what’s been expected for decades. There are many problems to this approach in healthcare.
Some are obvious and some are less so. The most notable problem from my perspective is that we really know clearly that not all medical problems are treated successfully with pills. This has become increasingly clear as we investigate the health of Americans in a general sense. The statistics are profoundly clear that we are an unhealthy society. Without wanting to restate the well-known, we do know that one third of all Americans are obese, two thirds are overweight, and the frightening rise of diabetes, hypertension, chronic inflammatory diseases, and sleep apnea syndrome have been well documented statistically in recent years.
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