A LETTER TO PATIENTS WITH CHRONIC DISEASE, THOUGHTS OF A PRIMARY CARE PHYSICIAN

I found this very interesting and thought I would share:-

.“A Letter to Patients With Chronic Disease

by Rob on July 14, 2010 •

Dear Patients:

You have it very hard, much harder than most people understand. Having sat for 16 years listening to the stories, seeing the tiredness in your eyes, hearing you try to describe the indescribable, I have come to understand that I too can’t understand what your lives are like. How do you answer the question, “how do you feel?” when you’ve forgotten what “normal” feels like? How do you deal with all of the people who think you are exaggerating your pain, your emotions, your fatigue? How do you decide when to believe them or when to trust your own body? How do you cope with living a life that won’t let you forget about your frailty, your limits, your mortality?

I can’t imagine.

But I do bring something to the table that you may not know. I do have information that you can’t really understand because of your unique perspective, your battered world. There is something that you need to understand that, while it won’t undo your pain, make your fatigue go away, or lift your emotions, it will help you. It’s information without which you bring yourself more pain than you need suffer; it’s a truth that is a key to getting the help you need much easier than you have in the past. It may not seem important, but trust me, it is.

You scare doctors.

No, I am not talking about the fear of disease, pain, or death. I am not talking about doctors being afraid of the limits of their knowledge. I am talking about your understanding of a fact that everyone else seems to miss, a fact that many doctors hide from: we are normal, fallible people who happen to doctor for a job. We are not special. In fact, many of us are very insecure, wanting to feel the affirmation of people who get better, hearing the praise of those we help. We want to cure disease, to save lives, to be the helping hand, the right person in the right place at the right time.

But chronic unsolvable disease stands square in our way. You don’t get better, and it makes many of us frustrated, and it makes some of us mad at you. We don’t want to face things we can’t fix because it shows our limits. We want the miraculous, and you deny us that chance.

And since this is the perspective you have when you see doctors, your view of them is quite different. You see us getting frustrated. You see us when we feel like giving up. When we take care of you, we have to leave behind the illusion of control, of power over disease. We get angry, feel insecure, and want to move on to a patient who we can fix, save, or impress. You are the rock that proves how easily the ship can be sunk. So your view of doctors is quite different.

Then there is the fact that you also possess something that is usually our domain: knowledge. You know more about your disease than many of us do – most of us do. Your MS, rheumatoid arthritis, end-stage kidney disease, Cushing’s disease, bipolar disorder, chronic pain disorder, brittle diabetes, or disabling psychiatric disorder – your defining pain - is something most of us don’t regularly encounter. It’s something most of us try to avoid. So you possess deep understanding of something that many doctors don’t possess. Even doctors who specialize in your disorder don’t share the kind of knowledge you can only get through living with a disease. It’s like a parent’s knowledge of their child versus that of a paediatrician. They may have breadth of knowledge, but you have depth of knowledge that no doctor can possess.

So when you approach a doctor – especially one you’ve never met before – you come with a knowledge of your disease that they don’t have, and a knowledge of the doctor’s limitations that few other patients have. You see why you scare doctors? It’s not your fault that you do, but ignoring this fact will limit the help you can only get from them. I know this because, just like you know your disease better than any doctor, I know what being a doctor feels like more than any patient could ever understand. You encounter doctors intermittently (more than you wish, perhaps); I live as a doctor continuously.

So let me be so bold as to give you advice on dealing with doctors. There are some things you can do to make things easier, and others that can sabotage any hope of a good relationship:

Don’t come on too strong – yes, you have to advocate for yourself, but remember that doctors are used to being in control. All of the other patients come into the room with immediate respect, but your understanding has torn down the doctor-god illusion. That’s a good thing in the long-run, but few doctors want to be greeted with that reality from the start. Your goal with any doctor is to build a partnership of trust that goes both ways, and coming on too strong at the start can hurt your chances of ever having that.

Show respect – I say this one carefully, because there are certainly some doctors who don’t treat patients with respect – especially ones like you with chronic disease. These doctors should be avoided. But most of us are not like that; we really want to help people and try to treat them well. But we have worked very hard to earn our position; it was not bestowed by fiat or family tree. Just as you want to be listened to, so do we.

Keep your eggs in only a few baskets – find a good primary care doctor and a couple of specialists you trust. Don’t expect a new doctor to figure things out quickly. It takes me years of repeated visits to really understand many of my chronic disease patients. The best care happens when a doctor understands the patient and the patient understands the doctor. This can only happen over time. Heck, I struggle even seeing the chronically sick patients for other doctors in my practice. There is something very powerful in having understanding built over time.

Use the ER only when absolutely needed – Emergency room physicians will always struggle with you. Just expect that. Their job is to decide if you need to be hospitalized, if you need emergency treatment, or if you can go home. They might not fix your pain, and certainly won’t try to fully understand you. That’s not their job. They went into their specialty to fix problems quickly and move on, not manage chronic disease. The same goes for any doctor you see for a short time: they will try to get done with you as quickly as possible.

Don’t avoid doctors – one of the most frustrating things for me is when a complicated patient comes in after a long absence with a huge list of problems they want me to address. I can’t work that way, and I don’t think many doctors can. Each visit should address only a few problems at a time, otherwise things get confused and more mistakes are made. It’s OK to keep a list of your own problems so things don’t get left out – I actually like getting those lists, as long as people don’t expect me to handle all of the problems. It helps me to prioritize with them.

Don’t put up with the jerks – unless you have no choice (in the ER, for example), you should keep looking until you find the right doctor(s) for you. Some docs are not cut out for chronic disease, while some of us like the long-term relationship. Don’t feel you have to put up with docs who don’t listen or minimize your problems. At the minimum, you should be able to find a doctor who doesn’t totally suck.

Forgive us – Sometimes I forget about important things in my patients’ lives. Sometimes I don’t know you’ve had surgery or that your sister comes to see me as well. Sometimes I avoid people because I don’t want to admit my limitations. Be patient with me – I usually know when I’ve messed up, and if you know me well I don’t mind being reminded. Well, maybe I mind it a little.

You know better than anyone that we docs are just people – with all the stupidity, inconsistency, and fallibility that goes with that – who happen to doctor for a living. I hope this helps, and I really hope you get the help you need. It does suck that you have your problem; I just hope this perhaps decreases that suckishness a little bit.

Sincerely,

Dr. Rob

Post Script: This post has generated a huge amount of conversation and interest (as witnessed by the large number of comments!). I very much appreciate the dialogue it has spawned both here and across the web. I’ve subsequently written follow-up posts explaining my thoughts in more detail – largely in response to the comments here. One of them discusses in more detail my own experiences as a doctor and the second talks of the importance of knowing and being known. Reading these will give you a better picture of my thought process and perspective on this.

Dr. Rob"

more-distractible.org/2010/...

11 Replies

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  • Thank you for sharing that. Doctors can't possibly know everything about every illness, disease or ailment and I am sure many would very much like to fix every patient.

    Having a great doctor who understands chronic illness because she has one herself, all be it not BD, she can relate to every day struggles of chronic illness. C x

  • Thanks Tigerfeet

    Dr Rob - seems like a normal decent kind of doc who actually listens.

    Its just a shame that some consultants 'team' members are so far up themselves trying to impress their trainee docs. Yes I am in a bit of a mood. I think I seem to be sent to the docs who want to tell You what You are going through . I think I need to avoid docs like the plague!!!

    MFG x

  • Wow! this is very nice and heart-filled. I feel a bit envious of those who have this doctor as their primary care physician! I have had a very painful journey just to get my diagnosis of Behcet's and along the way, I had way too many bad experiences with doctors. So many of them were ignorant to me; telling me that I wasn't sick or that I wasn't really in pain; telling me to just "grow-up and get over myself" and to just accept my "bad skin and acne"; and the worst thing of all was when a group of doctors in the hospital accused me of taking razor blades to my hands and feet and to sitting there picking at my skin-- and really the reason they said this was because they weren't capable of figuring things out and finding the answers, and they didn't want to admit their limitations or lack of expertise. A good doctor isn't one that is able to always solve the puzzle and find all the answers-- a good doctor is one who despite their limitations, they are still willing to put each patient first and try their best to learn what they can to help each patient to the best of their ability-- then when there is only so much they can do in their own scope of practice, they are willing to graciously and quickly send their patients in the right direction, where they can get the help they need. Doctors aren't God, but many of them try to pretend they are-- to me, those are the "bad" doctors. Along the way, there were some of the"good" doctors involved in my journey-- even though they couldn't help me in the end, they were still caring and very professional in their mannerisms-- they knew I was sick and in pain, and didn't try to tell me otherwise; and I was greatful to them for telling me the truth that my illness was out of their expertise, knowledge, or practice. Its just really too bad there aren't more doctors like this out there, especially GP's because they're the ones who we depend on most of the time.

    -Jenna

  • Btw, thanks Tigerfeet for sharing this with everyone :)

  • What a beautiful letter! I've always thought some doctors are frightened by chronic diseases. I know I would be if I were a doctor. This letter helped me understand so much and I will remember it when I see my doctors. Thank you so much!

  • Tigerfeet that letter was fantastic, and a true insight in to how some doctors trully feel. I have done all those things to help Jaida get the best possible care, especially the part, not to come on too full on. Mind you its hard at times when I'm the mother helping describe my daughters pain. I thankfully now have a rheumatologist I trust but do wonder if the extrem pain still scares her a little. thanks heaps. xx

  • It's always useful to share these things, I know I post a lot of stuff, but to me if one person gets something out of it then it's worth it. :)

  • Hi, I thought that letter summed it up nicely - the balance between 'good' doctors and also how to be a 'good' patient.

    When I was in hospital this last time they were considering changing a medication that I had only recently been put on by another specialist. When I asked if Dr ... would be 'miffed'. The answer was 'no, and if he was the type of doctor that would be miffed then you should put your running shoes on'. It was then explained that they often shared 'difficult cases' and were quite happy to share ideas with treatment.

    It does help as a patient to know what is going on in the background.

  • great find tigerfeet great insight into the mind of a proper docter and also a very good insight as to how patients should think as well a always said a spoon of sugar gets people a lot further in life than a spoon of salt !!!

  • Wonderful Tigerfeet and keep on posting...you find some brill stuff.

    I am lucky I have an amazing GP who believed in me, THAT IS PRICELESS.

    I try to be a good patient for her tho :-)

  • Thank you so much for this letter. Really helpful to me who is at the beginning of this disease. I may even show my doctor it to give him confidence x x

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