Physician, Heal Thyself: The Fraught Journey to Be Well in America
He leaned over me, all six foot three inches of him, his big belly touching the outside of my right forearm as he did so. His white coat fell forward, along with the stethoscope.
The intern, a young man in his twenties, stood off to the left, watching carefully. The doctor peered at my face, studied what I already knew was a precancerous lesion on my chest, and went over my whole body to see if there were any others. This took about three minutes. He froze the lesion. Happens regularly, from my youth growing up near Florida beaches.
Then he began lecturing me about sunscreen.
I interrupted him. Graciously, but still. This is a lecture I don’t need and am not in the mood for any more. The condescending delivery of what I should know. Should do.
“All due respect, doctor, I spend a lot of time above 11,000 feet. Most of my family has had skin cancer. I am outside a great deal in the tropics. At the very least I wear 100 SPF and keep my head and body covered. I do adventure travel all over the world. I am never outside without protection.”
He leaned back, surprised.
I eyeballed him through his thick glasses. When he stood up straight his big belly stuck out like a woman who is nine months’ pregnant.
“Sun can be reflected off the sand as well,” I added.
He stepped away from the exam chair and looked me over.
“You’re not like most of the people we get in here,” he said.
No I’m not. And therein lies the problem, doctor.
As someone who gets medical care at the VA, such as it is, I run into this all the time. At 65, the age where most of my military peeps are hunched over with pain, disease, addiction, years of physical abuse and neglect, most of my VA docs are far more accustomed to lecturing people about their smoking and opioid habits, their bad diets, weight loss and lack of exercise. They are far more accustomed to dealing with men, although that’s slowly changing.
What bothers me is that doctors like this dermatologist make all kinds of inaccurate assumptions about me and women like me concerning our lifestyles and habits. They don’t ask us a single question which would establish a solid baseline from which to have a competent conversation. We get treated like ignorant children. I can’t speak for others, but this is hugely insulting.
The VA is hardly alone in this, albeit they’re worse due to the general population they serve. When I am referred out for specialty care, I run into the same biases, the same tendency to make assumptions and start a long lecture.
It isn’t my problem that I might be an outlier. What is my problem is when a caregiver offers medical advice or solutions for problems I don’t have, diseases I don’t have, symptoms I didn’t describe simply because a large percentage of the population experiences them. That’s not doctoring. That’s a set up for significant problems down the road. It’s also lazy as hell. The older I get, the more I am misdiagnosed. The more procedures get recommended, usually those which may be age-typical but for me are often wholly uncalled-for.
My friend Jill’s 95–year-old mother had a doctor who was pushing pills at her constantly not because she had specific problems but because of her age. Deen was very competent. To her credit, she got online and did her due diligence. Every single time she went back to her doctor and said no. When she did succumb a few years ago, she was still living independently. When she fell it had nothing to do with polypharmacy. Sometimes we just fall- on the ice, on a stair, whatever. At any age. I do, too. But not from meds. Deen wasn’t going to drink the Koolaid. As a result she had a long, productive life with her brains fully intact.
Here’s the piece. This is the same kind of thing that happens each time I upgrade my phone at a Verizon store. The salesperson launches into a litany of features about things I could care less about because I don’t use them. I don’t have an interest, and I don’t have a need. This is how salespeople lose sales. Most of us can relate.
As someone who has trained sales for a living, one thing I’ve learned to do right up front is ask how someone is going to use a piece of equipment. Or a training. Or me as a consultant. Makes no difference. Find out what they know. Sometimes people claim knowledge they don’t have. It’s up to us as professionals to ask thoughtful questions which reveal those gaps without embarrassing or shaming the client. This goes for medicine, too.
A good professional doesn’t assume ignorance. More and more of us at any age are doing research on line, and many of us are coming in loaded for bear. That doesn’t mean we know what we’re talking about. It means that we have launched inquiries. That would suggest that we likely possess a brain cell or two, and have questions of our own for the doctor. The condescension that many of us get from our doctors is both an insult as well as a complete disregard for the work we might have done in advance.
Over the past six months I’ve done a series of blog articles for a doctor and holistic healer down in Albuquerque. Every single one of her patients (please note, she’s first and foremost a medical doctor) from a brilliant male engineer in his seventies to women of all ages have told me that their doctors don’t listen. Pooh-pooh their symptoms. Invalidate their pain. Shove anti-depressants at them when a thyroid gland was the real issue. In one case, the man was told to put his affairs in order. He’d be dead in six months. Last time I spoke to him it had been several years, he was about to get married, and was at that moment getting ready to climb on his roof to do repairs in 35 mph winds. He was just fine. His doc was supposed to be one of the country’s best cardiologists.
“Oh you’re just stressed, you need a counselor. Here, take Zoloft,” one woman’s doctor advised. Her adrenals had nearly shut down. Those small, thumb-sized glands just above the kidneys can kill if they aren’t treated properly. They have a huge influence on our overall health.
While on one hand, I am well aware that the overwhelming influence of insurance companies forces doctors to spend less time with us, on the other what time we do have needs to be well-spent and focused on outcomes that work. Not fast fixes, pharmaceuticals that often create more problems than they solve, and fake concern about our welfare which is expressed in failing to ask us intelligent questions. Those good questions force us, as both client and caregiver, to think, learn and explore our own knowledge. This is what real doctoring looks like.
In its most ancient sense, doctoring is teaching.
To offer a superb example of what this looks like in practice, I have been working with a very talented Physician’s Assistant as it relates to my forty-year history of severe migraines. I get up to twenty a month. Brandon spent nearly two hours with me until we identified a pattern, figured out a protocol. Two shots to the occipital nerve, and the headaches went down to two a month. I was off meds, off the Imitrex (which can cause strokes) and living vastly better. This after four decades of tests, neurologists and people who had simply said “Live with it. Here are your pills.” Pills that can kill or cripple via a stroke if you take too many.
This PA worked with me diligently to find a solution that four neurologists couldn’t find, didn’t offer, and gave up on. They wanted me to inject Botox — 31 shots, every other month. I hate needles. They hurt. This would have been worse than torture. Six times a year.
Brandon and I worked as partners. Found a workable solution together.
That’s good doctoring. Yet PAs aren’t trusted as well as doctors, even though they can prescribe.https://www.bartonassociates.com/blog/i-want-to-see-a-real-doctor-how-to-talk-to-patients-who-question-your-abilities-as-an-np-or-pa/ Many are better than doctors because they aren’t burdened with the God complex that cripples the doctor’s ability to be humble in the face of what they don’t know or understand.
A journey to true health doesn’t have to be a battleground. Yet increasingly it is, not just because of the cost. It’s also because too many of those who provide health advice are hobbled by the systems that employ them or their own attitudes about their patients. Or both.
In the 1980s I bought a small Ford pickup truck. During the test drive, I slammed on the brakes, after warning the salesman to buckle himself up. To which he giggled, then nearly went through the windshield when I did precisely what I told him I was going to do. I then whipped the little truck into some hard turns in a figure eight. Got up to speed and saw what she could do. The salesman was Caspar the Ghost. When we got back he made a beeline for the bathroom. I bought her, because I trusted her. We went a long way together, safely.
So here’s what I recommend.
Caveat emptor. Let the buyer beware. As consumers of health care, let’s be as picky as we are when we’re shopping for a brand new car. Kick the tires. Test drive. Brake it hard and whip it around tight turns at speed. Check the instrument panel to see if it communicates effectively. Make sure we can trust its performance. Because doctors, just like cars, aren’t all built well, built to last, or ensure performance when the going gets rough. They can look great but still be a piece of junk.
And you don’t want that managing your healthcare.