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I go to my neurologist and say that my back still hurts like hell 73-days
after I crushed my first lumbar vertebra, and I ask him what I should do. He proposes a kind of
operation called a kyphoplasty in which a balloon is stuffed inside the
vertebra, inflated with air, and filled with quick-hardening cement. Now, I
know that the AAOS (American Association of Orthopedic Surgeons) doesn’t much
like kyphoplasty, but I also know it’s commonly done because there aren’t a lot of great alternatives, and because it’s a low-risk
moneymaker that doesn’t require a high degree of doctorly skill and
intelligence. Still, it is surgery, and no
surgery is so minor but what it can’t mess you up.
So,
I ask him if maybe he could he hold off on the surgery for awhile and send me
to physical therapy first, and he says that, yeah, that might work, and he
gives me a PT referral. I then ask him whether an AAOS-recommended drug named
Calcitonin might help, and he says it might, and he gives me a prescription. He no doubt realizes by now that I’ve been reading about my problem on the Internet,
and a lot of doctors hate it when that happens because it’s ever so much easier
and more profitable when sick people keep their mouths shut and do as they’re
told.
Next, I ask him what he thinks of radio frequency ablation as a less
invasive alternative to kyphoplasty, that is if it turns out that PT and
Calcitonin aren’t enough to get me back on track, and as soon as I say this, he
groans and puts his head in his hands. I’ve never seen a doctor do that before,
so I just sit there looking at him and wondering what his next trick will be.
Not a very good one as it turns out, because all he does is to change the
subject. I don’t remember what he changed it to, because I’m thinking, wait just
a damn minute here, there’s a question on the floor, so I interrupt him as
gently as I can (doctors tend to be childish and fragile) by saying, “From your
reaction, I assume you consider RFA too absurd to discuss, but before I consent
to surgery, I very much want to investigate less invasive options, and from
what little I know of RFA, it sounds promising, plus it’s a whole lot less
scary than having my vertebra stuffed with a cement that might escape and wreak
havoc with my spinal cord and surrounding vertebra.” He says, “I have two
colleagues who perform the procedure, and I will refer you to one of them if you
would like.” You
will note that, if I hadn’t made some suggestions, only one treatment would have been proposed, and it wouldn’t have been the preferred one. He showed no empathy,
volunteered little information, and became impatient with questions. In
other words, he behaved like a typical doctor except for the groaning and
head-holding part, idiosyncrasies that brought his grade for the visit down to a D+.
If
you’re new to being a patient, you need to know that you can get better
treatment if you take an active role in researching every aspect of your
problem. Here’s why:
1)
You will better understand what your doctor is talking about, and you will know what
questions to ask in response.
2)
Your doctor will take you more seriously even if he resents your unwillingness
to treat him like a demigod.
3)
Doctors sometimes fall behind on the latest research, so it's possible that they might learn from you.
4)
Doctors like to stay within the confines of a limited number of well-beaten
paths that they can walk without thinking, and this means that they tend to employ
a surprisingly limited number of drugs, tests, and procedures.
5)
Doctors tend to know little about treatments that fall outside their area of expertise.
6)
You’ll be less likely to submit to a dangerous and expensive procedure that
offers little if any promise of helping you.
7)
If you run into an authoritarian doctor who takes the attitude that, “I AM A DOCTOR. How DARE you
learn on your own; how DARE you
question anything I say; and how DARE
you suggest other treatment possibilities,” it will enable you to find a good
doctor sooner.
8)
You will feel strong, smart, and in control.
9)
You will gain interesting knowledge that you can use to your own benefit and the benefit of others.
On the downside, it’s
emotionally difficult to assume what verges on an adversarial relationship with your doctor, but,
sad to say, the alternative is oftentimes to allow your doctor to run all over
you by treating you like you’re worthless and stupid. Obviously, not all
doctors are callous, arrogant, unsupportive assholes, but based upon my experiences
with scores—at least—of them, I can but observe that most are. Yet, you
need them, so the trick is to find a way to relate to them that is as
beneficial to you as possible. I’ve learned that this means taking an active
role in your own care even if they don’t like it, and being willing to find
another doctor if they dislike it enough that it’s impossible to work with
them. If this should happen, it won’t be your fault. You will simply be doing
what your doctor gets rich from charging hurting people for, which is to see
that they get the care they need.
A
relative named Patsy broke her back at the same time I broke mine, only her
break seems to have left her in considerably more pain. Her doctor prescribed
Vicodin, a weak painkiller, that would have been adequate even if it had
worked, which it didn’t due to the fact that it made her too sick to take it. So, what does her
doctor do when she tells him she can’t take her medicine? Nothing. Despite the
fact that he had myriad painkillers to choose from, he left her in pain for no fucking reason. If he had been my
doctor, I could have proposed a half-dozen alternatives off the top of my head,
but because Patsy knows nothing about pain control, or medicine in general, or
how doctors tend to behave, she went home assuming that this man
whom she had gone to for help when she was frightened and in pain, had done his
best to help her and was out of options. This is what happens to people
who are ignorant or passive, and Patsy was both. I can find a lot of reasons to
mistrust and despise doctors and very few to regard them positively. So, yet
again, I will tell you that you have to look out for yourself. Ironically, you
need strength the most when you have it the least.
