Attitude
The winds of change are blowing strong. What we really need is change in physician attitude towards patients to restore confidence in patient care. What? Physician attitude is a problem? I believe so. Why? I will tell you why.
Recently we had a mother bring her daughter into the office for an evaluation of a weight problem. Her daughter had suddenly gained fifty pounds over a three month period of time. Her daughter was an athlete, worked out every day and tried to eat as healthy as she knew how. Her mother took her to their pediatrician for an evaluation. Her pediatrician took a short history and then sat down in his chair and barked out, "You're Just Fat! Stop eating so damn much. Exercise more. You're just fat!" He got up and walked out of the room leaving both mother and daughter in tears.
Her mother decided to take her daughter to several other physicians. All of them told her that her daughter was a closet-over-eater, she needed more exercise and her daughter needed to be comfortable with being big. So mom abandoned the healthcare system and looked to the internet for help. Eventually she created a list of potential conditions that could cause her daughter's health change. She also searched for a physician who could answer her questions without questioning her questions. She spoke to fellow employees, hair designers, and church members. She prayed about her daughter and asked God to deliver the best physician for her daughter. No answers were revealed as her daughter gained another twenty pounds.
Her mother went to see her own physician for a blood pressure problem. She had developed anxiety as a result of worrying about her daughter's condition. Her physician told her he would call a pulmonologist friend of his who spoke highly of a physician in Memphis who helped him when no one else could. The pulmonologist was in practice in Jonesboro, Arkansas. Her mother left her doctor's office with a little hope, but not much.
Two weeks later, her physician's nurse called and gave her the number of the Stone Institute. She called immediately and found out that our office was scheduling four to six months out. She persevered regardless of the wait time and brought her daughter to the office for blood work and clinical testing. As fate would have it, a new patient had cancelled just around the time her daughter's testing results were available. Her daughter was inserted into the schedule.
I remember I was wearing a Michigan State Spartan Football Jersey when I walked in the room to see her daughter accompanied by mother. Her mother looked at me and said, "When do we get to see the doctor?" I looked at her, "When do you want to see him. He's very busy." She was a bit anxious, "As soon as possible!" I said, "Okay. He's in front of you. Good morning." Her mother turned many shades of red. Her daughter said, "You don't look like any doctor I've ever seen." I said, "Thank you. I work at that."
This visit was filled with details. Three or more hours of detail after detail. Her mother peppered me with questions and I answered them all. The young woman had developed Hashimoto's Thyroiditis, probably related to an Epstein-Barr viral infection she had about the time she started gaining weight. Her weight gain gave way to elevated insulin levels. Essentially she was hypothyroid and had acquired insulin resistance. I prescribed a number of food style changes, natural thyroid medication and added two herbal adaptogens to help sensitize her insulin receptors. I told her mother to look up information about Hashimoto's Thyroiditis on the internet and come back with more questions. She did just that. After a few follow-up visits, her daughter began to experience weight loss, more energy and less brain fog.
Her daughter lost fifty pounds over four months. After which time her mother took her back to the original pediatrician who insulted her daughter's character. Her old pediatrician walked into the exam room, "How's fatty?" Her mother stood up with her daughter. The pediatrician looked at her, "Fatty no more. What happened?" Her mother stated loudly, "She had Hashimoto's Thyroiditis and Epstein-Barr infections. She's better now." He replied, “Who says so?" Her mother stood tall, "Doctor Merigian." He replied, "That quack? He's crazy." She just smiled, "Funny. He said you would respond that way. He's right again. I think you're a fraud. We won't be back. Good bye." She and her daughter marched out of his office, never to return. Her daughter is doing fine now. Who knows how the pediatrician is doing.
Recently, I have heard patient's recite comments made to them by their physicians when their physician's treatments are unsuccessful. "It's all in your mind or you're making this up or you just don't wanna work anymore or you're seeking attention or there's nothing wrong with you or stop eating so much or you're just lazy or you're not sick or just work out or you just sleep too much or your lab tests are fine, it's just your imagination or you're just getting old....." The excuses for physician ignorance goes on and on and on.
Dismissive comments by physicians who are frustrated that their training and expertise could not help them help their patient are much too common these days. Many of the physicians have the assumption that their patients are not ill, they are drug seeking or just plain old faking. I believe physician attitude has changed dramatically over the past five years. Patients are their customers, but there seems to be an effort on part of some physicians or their staffs to almost dehumanize their patients so they can refuse care or insult them when they see fit. This is dangerous territory. By the nature of their profession, physicians are obligated to care for the infirm without judgment. If they are medically ignorant about helping a patient with unusual symptoms and signs, at the very least they should not denigrate them because of their own lack of insight.
All people need help, guidance and support in many ways. Not every illness presents to a physician in a textbook classic way. Diseases have infinite ways of showing up and can mimic other diseases at the same time. New diseases are identified every day. Keeping up with the vast field of medicine is a full-time all-consuming activity. It’s okay to say "I don't know...." when you really do not know. It's not okay to make-up false facts in order to promote a procedure or explain a symptom or treatment of an illness (that isn't true).
Attitude. It's everything. I hope 2018 will bring better attitudes everywhere, but most certainly in the health delivery system. It begins at the top: Patient respect is not the same as HIPPA compliance; Physician attitude matters to all of us everywhere.
Doc