Wednesday, December 18, 2013

Games Doctors Play

The last few months I have been seeing a few doctors and over this period, I have come to recognize certain patterns of interaction that are quite common.  These are a sort of play based on personality and training; sometimes these are innocuous but at times they may be irritating or even deleterious.  It's good to watch out for these and not get sucked into playing along.  My golden rule is never to rush into any drastic or invasive treatment that doctors recommend (even if they say seconds are precious).  It's always good to excuse oneself for at least a few minutes (if not for longer), talk to reliable friends or other doctors before being pushed into any action.  As for the things we have to deal with (other than our medical conditions), here's a short list:

1) Brick in the wall: (taken from Pink Floyd's song of the same name) - 'All in all, you're just another brick in the wall'.  Most likely you're being used to ramp up the hospital rather than the other way round.  But this feeling of not being treated as a person begins right from when you step into the hospital.  Don't take it personally!

2) P2C2E: (from Salman Rushdie's Haroun and the Sea of Stories) : Process Too Complicated To Explain.  Be wary when you hear such things- doctors will often fling them at you.  Nothing is too complicated to explain (at least not in biology), also be wary of oversimplification and inane analogies - there are few analogies that work for the human body and mind (as for the spirit- don't worry about it, doctors will not even mention it!).  Doctors who stick to facts (especially backed with proper medical references) are few to come by but worth paying attention to.

3) Carrot and Stick:  Very common - used sequentially or in random combinations, to push you into opting for something you may not be comfortable doing at that moment.  This is exacerbated by waves of urgency that the doctor suddenly begins emitting or sometimes a hypnotic glare.  A red herring such as a warm, sympathetic smile may sometimes be thrown in.  Watch the doctor for all these signs and watch yourself for inner reactions!

4) No Option: A very common game.  Doctors don't often use these exact words though last week I met one who did.  I promptly interrupted him and said, "There is always an option."  And there is!  The final decision (whether to begin a treatment and, often, even when you want to quit) is yours "against medical advice", though it may be.  Don't be afraid of these words or of taking your time to figure out whether you want to follow the doctor's advice.  Of course, every option has a consequence and you must be willing to face it.  But even if there is only one course of treatment possible in modern medicine, you may still want time to decide which doctor and hospital you want to go to and may want a second opinion.  So, even for sub-choices (once the main decision is taken), options may need to be explored.

5) Trust Me:  Trust cannot be induced, it emerges and flows freely when conditions for it are conducive.  I wouldn't trust a doctor unless I (or someone I rely upon) feel they are worthy of it.  I prefer to trust medical literature and analyses.  If you have reasonable cause for doubt, it's good to get a second opinion or talk the matter through with someone who is familiar with the subject and preferably with recent medical research or guidelines.  I also wouldn't trust internet chat sites though I use the internet a lot to collect technical medical literature.  There are certain official (and relatively unbiased) sites where things are explained in simple terms (medline plus is a good one for example).  It's good to read a little especially when drastic new therapies are being prescribed.  It's also useful to keep in mind that very rarely are those shiny new drugs and methods that doctors dangle before us, as attractive as described.  Medicine can do a lot of good but sometimes the side effects, the length (and expense) of treatment and its success rate are not explained as clearly as one desires.

6) The Three R's R'nt So Important: Trust your school teacher in this respect- they sure R!  Make sure you can read (and understand) the prescriptions.  Doctors also sometimes give the same dosage of medicine to one and all irrespective of their physical condition (body mass, age, other medical complaints they have) but this is not so common and one deals with it if terrible reactions occur.  Sometimes doctors mistakenly write milligram (mg) for microgram (mcg) - it's happened to me twice!  But chemists (or pharmacists) are quite used to this and allow for it while dispensing medicines.  But doctors may still have a few tricks up their sleeve that we may not know of.  A doctor told me last week, "You biologists think you know everything.  But one plus one is not two in medicine, like it is in biology!!!"

7) Next Patient!:  Don't be pushed by the 'Next patient' war cry that doctors often use - take your time to read and understand (and ask if you have any questions).  Also make sure you have enough time to put back all the papers and reports that are strewn over the doctor's table, into a folder, before you leave their office.  Good luck!

Finally, here are a few quotes on medicine, healing and curing, written by exceptional doctors, that I like:

"In a community like ours we have put all the emphasis on cure.  We want to be professionals: heal the sick....  But the temptation is that we use our expertise to keep a safe distance from that which really matters and forget that in the long run cure without care is more harmful than helpful.
   When we honestly ask ourselves which persons in our lives mean the most to us, we often find that it is those who, instead of giving much advice, solutions, or cures, have chosen rather to share our pain and touch our wounds with a gentle and tender hand.  The friend who can be silent with us in a moment of despair or confusion, who can stay with us in an hour of grief and bereavement, who can tolerate not-knowing, not-curing, not-healing and face with us the reality of our powerlessness, that is the friend who cares."     (Henri Nouwen, Out of Solitude)

"My advice is to live YOUR life.  Allow that wonderful inner intelligence to speak through you.  The blueprint for you to be your authentic self lies within.  In some mystical way the microscopic egg that grew to be you had the program for your physical, intellectual, emotional, and spiritual development.  Allow the development to occur to its fullest; grow and bloom.  Follow your bliss and be what you want to be.  Don't climb the ladder of success only to find it's leaning against the wrong wall.  Do not let your age limit your future growth as a human being...
   ...Remember I said love heals.  I do not claim love cures everything but it can heal and in the process of healing cures occur also."     (Bernie S. Siegel, Love, Medicine and Miracles)

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