Monday, October 31, 2011

Family Medicine: Prove the Patient Right

"Since I've been on that flaxseed, my knees don't bother me.  I've canceled my surgery.  I can't believe it!  They hurt so bad for so long.  Now the pain is gone!"
Five years later: "I feel better now that I got my knee replacement.  I should have done it earlier."  Very interesting.

"I can't take sulfa drugs for infections." "What happens if you take sulfa?"  "I don't know, I just know my mother gets a rash if she takes Sulfa, so she told my sister and I to never take sulfa since we might get a rash."

"I can't get a flu shot, because I got one in 1972 and later caught bronchitis. I don't want the bronchitis again.  I always respond well to Vick's Vaporub.  My grandmother used to rub it into our upper chest whenever we caught a cold.  They seemed to be milder and resolve faster with the Vick's ."

Things change, times change and so do patient beliefs.  We all have both positive/ enhancing and limiting beliefs of one sort or another.  Family Physicians get exposed to them every day from patient to patient and their family members.  Sometimes, it's our limiting beliefs (yes, the family physician's limiting beliefs) that get in the way of patient success. Sometimes, this surprises the patient, just as we're sometimes surprised at their positive or limiting beliefs.

How do we contend with our respective limiting beliefs that may deter clinical success?

I have a strategy called, "Prove the Patient Right."

Whatever their theory about what might happen should they follow a particular course of action, I add it to my considerations and treat it equally.  We deal with a lot of small probabilities already in Family Medicine, so what's the problem with adding another consideration to our differential diagnosis or treatment plan?

We have our experience and the medical literature to refer to for insights.  They have knowledge of themselves and their family plus personal knowledge of many health and medical situations and conditions.  Together, we can integrate our theories and share information to get the most favorable conclusion.

If I'm thinking their story, signs and symptoms could be a serious heart condition, I want them to be right with their theory that they had palpitations because they took too much over-the -counter cough syrup.  On the other hand, if they are afraid that their symptoms indicate they might have cancer of the bone, I want them to be proven wrong, but know I have to mention the bone cancer concern as I discuss the meaning of the symptoms and signs relative to the various tests for causation.

Together, we can share our theories, concerns and fears as we pursue their best health.  Prove the Patient Right and Prove the Doctor Right are helpful strategies for healthful lives.

3 comments:

SeaSpray said...

I was getting all excited when I read the flax seed statement. :) Because I live with chronic bilateral knee pain - bone on bone oa. I mostly just deal with the pain ..except for tramadl once a day, but not every day - just pick when I am most active and weight bearing. I don't want to do the knee replacement...but admittedly think about it.

I know from a clinical perspective ...Drs probably think I will relapse with the ureter constricting ...but I honestly believe this was the 11th hr and 59sec rescue that God has healed me with and I am grateful my urodoc worked with me one more time and even used a large stent and longer duration. I know God doesn't have to use stents and urodocs to perform a miracle ...but I also know he works through physicians. Guess I sound kind of crazy ...but I do believe this. So ..I guess I fall into that patient group ...but from a faith perspective.

It must be difficult to balance all these things out ..wanting to do what you feel is best for the patient ...but not in agreement with their position and of course the responsibility for sifting through that and deciding correctly falls on your shoulders.

You sound like a very compassionate Dr. :)

A. Patrick Jonas, MD said...

Thanks for your thoughtful comments, SS. Prayer is always a good health strategy. I was touched by your posts about the journey of you and your friend who recently succumbed from cancer. I mentioned your Blog in two other media (Blog Talk Radio show and presentation at FMEC-outlined in my post a couple weeks ago).
Your belief and passion will help your wholeness/oneness to manifest better which, I believe, is healthful.
pj

SeaSpray said...

I always appreciate your thoughtful/insightful comments. :)

Thank you for the mention. I will be blogging 5 yrs Nov. 13th and am still amazed people read what I write ..but do appreciate it. :)