Should we trust doctors? In view of the recent scandal about certification for radiologists in which questions and answers from prior tests were made available to prospective test-takers, that's not a trick question. One can only wonder how many other medical specialties are crowning their own with that coveted piece of paper swearing they are competent and trustworthy members of their chosen profession.
Also, think about the tab for the roughly twelve years of education required to qualify in a specialized area of medicine. Are medical students the best and the brightest, or just the wealthiest? Are they admitted to choice medical schools on merit or do they represent the nepotism of legacy admissions?
These are fair questions given the horror stories one hears. For example, a friend of mine was told she would never conceive a child. At the time she was six weeks pregnant. Another friend was bitten by a snake. "No," the doctors said. ""Can't be. No poisonous snakes here." By the time they conceded a near fatal bite his leg looked like an elephant's. A woman I knew had stage four cancer by the time her docs stopped telling her it was all in her head, as they are wont to do with women.
There are good doctors, of course, like Danielle Ofri, Susan Love, Atul Gawande, and Abraham Verghese -- who are also good writers - which suggests they are sensitive people with creative souls. But more importantly, I'd argue, they are probably good listeners and compassionate clinicians who care about the human condition. They have not lost the ability to think in holistic terms. They know that a "pain in the neck" or an "upset stomach" can suggest somatic illness caused by psychological stress, or that flu-like symptoms can mask serious diseases that require careful consideration versus the proverbial two aspirin and a phone call in the morning.
Over the years, working as a women's health educator and advocate as well as being an assertive health care consumer - for which I've often been tagged "non-compliant -- I've learned a few things I think are important in choosing a physician or other health care provider. Here are some of my "lessons learned."
First, interview the doctor or practice you are considering as your health care provider. Shop around if necessary. Talk to others who know the provider. You wouldn't choose a car mechanic without making sure she knows what she's doing. Why not give your body the same respect?
Don't be afraid to ask about credentials and experience. Where did the doctor go to med school? What's the scariest experience they've had? Have they ever been sued? A doctor who won't answer those questions, at least without breaking into a sweat, is probably someone you want to avoid. There is, after all, nothing wrong with asking questions that relate to competence.
Watch how the provider relates to you when you meet. Do they look you in the eye, smile readily, nod in acknowledgement? (Good clinicians are charged with observation. So are good patients.) Do you feel understood, respected, accepted as a partner in your health care? (If a doctor calls me by my first name, I expect to do the same. This is not a one-up, one-down relationship.) Do you feel you are getting the time your conversation warrants?
When you are going over diagnostic results that could be troubling or an important treatment plan, bring an advocate, someone who can take notes or ask questions. They can often be the "master of the dumb question," focusing on things you might later wish you'd asked. Persist with your questions until they are answered completely and understandably.
Ask for an evidence-based treatment plan. Find out what proof there is that the proposed treatment or drug course is safe and effective. Don't be afraid to ask for reference articles on the subject. And don't "swallow the pill whole." There may be more effective ways to remediate the problem than a prescription drug, which is often the lazy way out. Also, just because "your insurance pays for it" doesn't mean you need it. Express your preferences and stick to them unless you are convinced they are not viable.
These suggestions don't mean you're difficult, out of your league, or non-compliant. They simply indicate that you are an astute consumer who expects the best care possible from qualified individuals who really know their stuff and have your interests at heart. Anyone threatened by that expectation needs to have their head examined -- hopefully by a properly certified neurologist who hasn't squeaked through by looking at last year's test questions.