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Good evening, 66.1ers.
Some of you have been asking, sharing, thinking lately. About various medical issues, but all boil down to the same question. Goes something like this: "I'm not sure I'm getting the most out of my doctor's appointment. Can you help?" I'll try today. Whether you're having fertility issues, heart issues, or need a joint replaced, today's issue is about how to make the healthcare system (and your relationship with your doctor) work for you, instead of the other way around.
Ever notice how people call folks with "MD" behind their name "doctor", no matter what? Hadn't thought about this one until recently, when I was in a group in which a CEO kept referring to someone else as "doctor". Now, this "doctor" hadn't spent nearly enough time in school to get an MD or a PhD or anything else of the sort. He's just great at what he does, been doing it for a really long time. He was being called doctor out of respect for his ability to positively change peoples' lives, not because he was good at school. This was a bit of a lightbulb moment for me. Ever ask yourself, "If I didn't know my doctor had completed medical school, would I be inclined to call them 'doctor'?"? If yes, great! You've got a good person in your corner. If no, today's newsletter might be helpful?
There's an "automatic deference" to doctors in America. Many times, this is correct. If you've got a weird lump in a weird place, it's nice to know there's someone out there who's seen a million of them and knows what to do about it. But what happens when you're doing what your doctor says and nothing's getting better? Or when you can't get a timely response about whether you ought to go to the emergency room?
At the Mayo Clinic, we remind our patients of a few things the first time we meet them:
You're 1 leg of a 3-legged stool that makes up your pain management team. It's the patient + myself + a nurse or physical therapist. Get rid of 1 of those legs? You know what happens.
We know a lot about pain management, but you're the expert on you. Pay attention to patterns with your body, no matter how weird they may sound. If you think there might be something going on, there's a good chance there is! Please tell us.
Let’s think about it differently? You see your doctor for 30 minutes every few months at most, more commonly is once per year. All the while, you spend every minute of every day in your body. Who's going to know more about what's going on?
Nothing against doctors. Most of the doctors I know want to help their patients in every way possible. But it's usually the patient who has all the clues to what's going on. The doctor's job is to put them together to crack the case.
A friend of mine was going to the doctor for the first time in 3 years the other day. "How should I prepare?" 2 things: 1. Remember that any question is fair game, your doctor wants to help, and they can't help if they don't know what's on your mind. 2. Read this newsletter.
Story from my own life: accepted into the Peace Corps in fall 2016. Dream come true! Had applied and reapplied, finally got it the second time around. Now I'm moving to Zambia. Rural Zambia, the bush, the middle of nowhere. Of course, a physical and thorough medical examination are necessary. Do all that, low hemoglobin, Peace Corps says NO WAY. We can't support your situation. Sorry, but you're not going to be able to do this Peace Corps thing. If you think we're wrong, you can appeal it. Get some letters from doctors, fix the issue, all that. So we did that.
Went up, down, and sideways at the Mayo Clinic to prove that whatever was causing my low hemoglobin was no longer an issue. Colonoscopy. Endoscopy, CT scan. No internal bleeding. OK. No holes in the bucket! But the bucket is still not full. Hemoglobin is 10, normal is 13.5, good is 15 g/dL. Saw my Primary Care Provider at the beginning of all this, they referred me to a hematologist (Dr. Rodriguez) to really dig into it. Dr. Rodriguez ordered all those tests to make sure we didn't have a bleed to fix. Also saw a GI doctor to make sure they didn't have any concerns. Then Dr. Rodriguez said, "the normal way to fix this is oral iron supplements. Takes about 3 months to see meaningful improvement. But I'm thinking we need to go faster so you can do this Peace Corps thing. We'll infuse you 3 times and if you're healthy, your hemoglobin will be back to normal in a few weeks." Got the infusions, hemoglobin was 16 g/dL. No internal bleeding. Not done yet, though…
Dr. Rodriguez wrote a letter to US Peace Corps saying she had no concerns about me spending the next 2 years in a low-resource environment. But my PCP is the doctor who first found the issue. Needed their blessing, too. But they were out of town for 2 weeks. So they scheduled me with a colleague of theirs, explained the situation, and their colleague wrote a note as well. Got one from the GI doc, too. Now, in combination with the GI specialist who looked at the test results and saw me in person, Dr. Rodriguez who fixed my anemia, and the PCP team, we had 3 doctors vouching for my wellness. Submitted all the test results, lab results, and 3 doctors' letters to Peace Corps and voila! I was re-accepted to serve in Zambia. This all happened in a span of 6 weeks. Moral of the story? With physicians who care and a patient prepared to advocate for themselves, you can get a lot done. Thanks, Dr. Rodriguez!
Some other thoughts:
Doctors and other healthcare professionals are there to serve you. Don't mean to sound entitled. Doctors do a lot. Most are great, service-oriented professionals. But there are outliers. If it doesn't feel right, you can find another doctor. If you asked your lawn guy to mow once a week and he showed up once a month, would you stick with him?
Find someone you jive with. Doesn't have to feel like happy hour, but you should be willing (if not comfortable) to tell them everything they need to know about you (especially the "embarrassing" stuff!) to help you to the fullest extent possible.
Another friend: needed an orthopedic surgery. 2 ways to do the surgery. 1 tends to heal faster, the other has other advantages. Surgeon suggested the "slow-healing" approach. More reliable outcomes, that sort of thing. Friend didn't love that idea. What should they do? Get a second opinion! Remember the lawn guy?
A third friend has been seeing their doctor for some heart stuff. They were put on medications. Medications are mostly doing their job, but have some side effects. Side effects are survivable but not optimal. What else can we do? Asked this question of their primary care provider enough times and ended up with an appointment at a specialty clinic to see the doctor who's literally written the book on this stuff.
Remember: let the system work for you!
Have fun out there.
Marcus
P.S.
Going to write a Part 2 on this stuff next week. Will expand on this newsletter. If this week was about the big picture “What”, next week will be about the “How” so you know exactly how to make the most out of your doctor’s visits.
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