I don't think I'm unique in having a family that discusses
medical issues at the dinner table. But in a family with a doctor, sometimes discussions
– to the dismay of my children – are more colorful than they would like. I have
learned (mostly) to keep discussions from veering off track. For my family’s
part, they know there is a cardinal rule that must be obeyed: you are not
allowed to mention Google or Reader’s Digest when discussing medical facts.
That rule was recently broken by my wife, Catherine, but in an interesting and forgivable
way. Here's the story.
My wife takes a potassium pill – a common supplement – once a
day. As anyone who takes this pill knows, it is a big tablet. A horse pill,
some would say. And because of that, she wasn't taking it reliably. Some days
she could swallow it without too much difficulty, and other days she just
couldn't get it down. If she tried a couple of times without success, she just
let it go. That’s where Google comes in. In a worthy attempt to educate
herself, she went online, researched the medicine, and found out why she needed
it. Now, she is much more compliant... to a point. She won't take it if
she is alone, because she doesn't want to choke on it.
When she told this story at the dinner table, she concluded,
"Isn't that interesting?" To which I replied, "What is
interesting is that you didn't trust that because the doctor prescribed it for
you, you needed to take it." My daughter then remarked, "That's
because a lot of doctors are quacks." So much for respecting the medical
profession these days.
Of course, as a doctor's wife, Catherine very much respects
the profession of medicine, and I had a twinkle in my eye when I
"accused" her otherwise. My daughter's sarcastic analysis, however,
did sting a little. Long gone is the era of paternalistic medicine, where TV
doctor Marcus Welby, MD simply told his patients what was best and they
complied without question. Now patients come to our offices telling us what is best and expecting us to comply. And front line primary
care doctors are so strapped for time and paid so little for each office visit
that sometimes it is easier just to acquiesce.
Physicians must resist that temptation. Historically, perhaps
it was appropriate for the family doctor to be paternalistic when he knew his
patient so well – both inside and outside the office – and when he took care of
the medical needs of the entire family. Too often today, the primary care
physician is seen simply as the source of a referral to a specialist. The
gatekeeper moniker was a kind way of referring to the physician whose true role
was (as far as the insurance companies were concerned) to prevent specialist referrals rather than facilitate them. That is a
far cry from the position of a genuine coordinator of care who manages the
various specialists’ recommendations and knows all the medications that have
been prescribed. Such coordination takes a great deal of communication not only
among healthcare professionals but between the primary physician and the
patient as well.
All physicians – not just primary care physicians – must work
harder to earn the respect and trust of their patients. We must take the time
to explain the interventions we recommend and the medicines we prescribe. Those
horse pills will go down a lot easier with a little sweet talk and education along
the way. And our patients will be happier and healthier as a result. Now,
that's good medicine!
