Cancer log 53: Trust, but Verify
In a slightly different life, I would be a doctor. If I’d been a little less stubborn in college (and a little better at science), I would have followed the family path into medicine. My dad’s a doctor; both my sisters are doctors, my brother-in-law is a doctor, one of my best friends is a doctor. It’s what we do. One consequence is that generally, I trust doctors. I like to think if I’d followed that other path, I would have been a good doctor. That I would be conscientious and hardworking, that I would keep up on the current research and use my brain to the best of its ability to diagnose and treat with thoughtfulness and care. I’d also hope that I would remember that each patient is an individual, not a statistic, that although they wouldn’t know nearly as much about the general field, about most cases of their disease, as I would, that they would know their own bodies intimately, which is a kind of knowledge I’d never have access to. And I also hope I’d remember that my patient is alone and sick and scared, and that sometimes a few minutes of asking how they’re doing and actually paying attention to the answer may be better medicine than any treatment I can prescribe. I hope I’d use all of this, all of my abilities as a healer, despite the pressure of insurance companies, the demands of my colleagues in the practice, my own human limits of time and energy. But studies show that doctors are products of their society, that they inevitably carry the gender, race, class, disability, age, etc. biases that we all carry, and even the best medical training can only do so much to counter that. So I balance my knowledge of their good will, their absolute desire to do their best for each and every one of their patients, with my understanding that they are also human, and they will sometimes make mistakes. Yet this is not a reason to turn away from doctors entirely – I worry about the way that so many people, including many I know, avoid doctors. Sometimes it’s fear of the bad news the doctor may bring – but generally, whatever is wrong will stay wrong, and often get worse, and sticking your head in the sand rarely helps. Sometimes, they have had bad experiences with doctors in the past – ones that, for whatever reason, were judgmental, or blinkered, or hasty, or so coldly analytical as to border on cruel -- doctors who may even have made things worse instead of better. Sometimes patients have a deep distrust of Western medicine and/or big pharma, and turn to alternative practictioners instead – but while your grandmother’s herbs may well possess some efficacy, their anecdotal power is no substitute for thorough research, for a well-conducted double-blind clinical trial with reproducible results. (As one drug company researcher said to me recently, if St. John’s Wort actually did everything its proponents claim for it, big pharma would have jumped on that decades ago, and would be making billions from it.) In the end, medicine should be a respectful collaboration between the practitioner and the patient. Even though I generally trust doctors to want to do their best for me, I am all too aware of all the factors that can interrupt their ability to give the best possible care. So I proceed with caution; I trust, but verify. When seeking out medical care, I ask myself if this person seems alert, thoughtful, patient, kind. Do they actually listen to what I have to say, do they think about it and respond thoughtfully? If not, I change doctors – this can be hard labor in itself, no doubt, and harder to deal with when you’re already physically or mentally unwell, and even worse for those who may have to change doctors multiple times (perhaps because they run into a series of doctors who attribute all issues to excess weight, a common prejudice in our current society, or to female ‘hysteria’), but better that additional labor than leaving your body in the care of someone who doesn’t treat it properly. Enlist help, if needed. Ask for recommendations. There are better doctors out there. (And not incidentally, as you can, work to reform healthcare so that the poorest patients don’t also get the most harried, overworked doctors.) I research my own symptoms and condition in advance, keeping in mind that the information I have access to is limited, and my scientific background is even more limited. But I also remember that my doctor, with the best will in the world, is treating many different patients, with many different iterations of various conditions, and that I can sometimes offer her a valuable perspective, or even some recent research that hasn’t yet crossed her path. (I was more up-to-date on thyroid issues than one of my internal medicine doctors, for example, and that led to her referring me to an endocrinologist – who thankfully knew much more about the thyroid specifics than I did.) Your body is not quite all you have – but it’s a huge part of it, and when it’s struggling, everything else in your life is harder too. Your body is worthy of thoughtful care – your doctor’s, but also yours. We should all have thorough and competent health care (physical and mental) for when we need it. And when you’re facing something hugely difficult, like cancer, it makes all the difference in the world to have doctors you feel you can trust. Today, bloodwork, EKG, and biopsy to see if I actually qualify for the clinical trial. Onward.