Numerous medblogs lament those patients who take printed material to their doctor for an opinion. Whether it’s reams of information printed off the internet, or an advertisement for treatment of dubious merit, patients want their doctor’s input.
Not House recently wrote about one instance of a patient questioning an advertisement, yet the doctor failing to provide guidance (my words, not his).
How sad. I don’t know what that particular patient was thinking, but can remember a few times I’ve asked my doctor about specific treatments I’d learned about elsewhere. I appreciated my doctor’s help.
The first time, the topic was gallstones. At age 32 with a BMI of 21, I didn’t fit the typical 5F criteria. My gallbladder didn’t read the textbooks, though, and the ultrasound confirmed what my doctor suspected. Surgery was recommended.
Surgery? I don’t think so! I’m a firm believer in the adage minor surgery is something that happens to someone else. We are NOT cutting holes in me, not for any reason, unless we’ve tried every other option first. I went surfing (the ‘net) and discovered a treatment that many people claimed works well to get rid of gallstones and cost less than $20 (in contrast to the huge expense associated with a hospital admission and surgery). I compared a zillion different sites to analyze their common features, condensed everything to a single page, and took it to my doctor.
Was I trying to annoy him? No. He knows way more about medicine and how the body works than I’ll ever know. He knows what’s likely to work and what’s not. I trust his judgement and wanted his opinion. If there was a way to get rid of gallstones without surgery, I wanted to know about it.
My doctor glanced at my carefully prepared paper and handed it back without reading it, which was disappointing until I realized he’d seen the information before. “Some people find that this works to get rid of gallstones, but they will most likely form again. It’s not a permanent solution.” He still recommended surgery, but didn’t push. I asked his opinion, he gave his honest assessment, and I was able to make a choice based on what he told me.
The second time was different. A friend was seeing a kinesiologist for treatment of food allergies and recommended it for my family, too. Anyone with food allergies knows how difficult it can be to deal with severe limitations on your food choices, so we were willing to try anything. I went to an introductory meeting to learn more, but walked away skeptical. It sounded crazy.
My friend insisted it worked. My husband said we should give it a try. I checked around and found a kinesiologist who was on my insurer’s list of preferred providers. It must be legit if insurance was willing to pay for it – at least that was my reasoning.
Before scheduling an appointment for this strange new treatment, I talked to my doctor. My friend was seeing great results with her kids. I had doubts, though. Kinesiology… kinetic energy… same roots, but nobody could really explain how it worked. What did the doctor think?
He shrugged. It didn’t make sense and he didn’t think it would help, but if we wanted to try it, it wasn’t likely to hurt, either. I appreciated him taking the time to discuss it with me, but had hoped for a little more.
I discussed the doctor’s response with my husband, and since it wouldn’t hurt, we decided to give it a try. Does it come as a surprise to anyone that it didn’t work? Since then, information available on the web has exploded and I’ve discovered what a total waste of time and money kinesiology is. My experience is not at all unusual.
Sometimes I wonder why my doctor didn’t warn me what CAM really is, and why he didn’t provide a referral to a good allergist, instead. Then again, I don’t know if I would have listened. My friend thought it was the best thing since sliced bread, and I might have given more weight to her experience. I certainly won’t make that mistake again.
Recently, I asked my doctor about medical information I’ve read on the ‘net. I didn’t take him pages of printouts, just a few lines quoted here and there, amounting to just a few paragraphs. I find it more precise and less time-consuming to print someone’s exact words than to try interpreting what I thought the author meant and explain it to my doctor. He graciously read the quotes and then explained his perspective more fully than I ever would have dreamed.
I don’t think most patients should be printing out medical studies and imposing them on physicians. It’s insulting to imply that doctors aren’t keeping up on their CME and are ignorant about their field of expertise. That’s different, though, than asking a trusted doctor’s opinion. Patients could try alternative treatment getting medical advice. We could spend money answering advertisements from those who claim to have a cure for everything. When we ask our doctor first, we really want an answer – and trust that we’ll get it.
The physician that Not House observed failed his patient miserably.
∞ itis 
For me, personally, the big concern is how fervently the patient believes in that information. Especially if you’re not familiar with the patient, it’s hard to tell the people who are true believers in whatever therapy they’re proposing (and who will be greatly offended/hostile if you propose an alternative or question the value in the treatment they suggest) and the people who are genuinely curious and want their doctor’s medical opinion.
Many doctors are very loath to give their true opinions, medical or otherwise, for fear of alienating their patients or coming off as ‘close-minded’, as in your kinesiologist example.
The best strategy I’ve seen, from a physician end, is to come to your doctor with a list of questions/concerns you might have (just like you did in your latest example). That way, you’re not overwhelming your physician with information or appearing to call into question their training, while at the same time, enabling your concerns/issues to be addressed.
Actually I think most doctors don’t say anything for liability and political reasons. It’s often self-serving rarely altruistic behavior.
M