Give Me The Facts

Sometimes I get mixed messages from my doctors.

When they are unanimous in recommending a treatment, then it seems to me that other parts of the treatment plan should facilitate having that treatment occur.  That’s not what happened, though.  While I contemplate one particular situation that I’m currently facing, it occurs to me that there are broader implications that apply to other issues in healthcare.

From the standpoint of everyone pushing me to have surgery, it’s a good thing that I missed my RA meds while hospitalized.  Medicines that increase a patient’s risk of infection don’t make surgeons happy; that’s why surgeons tend to recommend discontinuing methotrexate one-two weeks prior to surgery, and Cimzia four weeks before surgery.  If the goal was to convince me that surgery is needed, it would seem that staying off the RA meds for another two weeks would be the most efficient way to get the surgery done as soon as possible.  Instead, I was given instructions to re-start the very meds that a surgeon will want me to discontinue before he’ll operate, prolonging this entire ordeal.

Apparently it’s important that I have surgery… but it’s not.

My doctors could have said, “The best treatment for this is surgery.  Ideally, you’d be off your medications for a month first, so you only have two more weeks to wait.  If everything goes smoothly, you can resume your meds a week later.”

Given my reluctance to have surgery, they could have added, “That would be my recommendation.  I know you don’t want to have surgery, so why don’t you think about it some more while trying your non-invasive method.  I’d hate for you to have to wait another month if you change your mind or this other method doesn’t work.  In two weeks you’ll know if your method worked, and then we can discuss the best way to resume your RA medications.”

Instead, it seems that I heard, “You can resume your meds in a week.  As to the other issue, the best treatment for this is surgery.  You’ll need to talk to a surgeon.”  By implication this means that about the time the mtx & Cimzia start working again, I’ll have to discontinue them for four weeks, dragging this entire process clear into next month.

It’s perplexing.

This week I’ve seen three doctors, including my family physician.  After his hard-sell pushing surgery while I was hospitalized and his discharge instructions including, “Come see me in 2-3 weeks; I will be writing you a referral to a surgeon!”  I expected that at my appointment I’d be handed a referral and given some facts on why that would be the most prudent course of action.  It threw me for a loop when that didn’t happen.

When I asked my doctor questions, all his answers gave the worst-case scenario and expanded to horrible possibilities I hadn’t even considered.  I sat there puzzled, thinking, “I’ve nearly reconciled myself to the idea of talking to a surgeon. That doesn’t mean I’ve agreed to have the surgery, but I’m willing to listen.  Now it sounds like you’re trying to talk me out of it!”

This all very confusing.  My doctor is usually excellent at answering questions.  In fact, when I write a list of my questions, usually I ask just one or two.  My doctor is so thorough that he answers most of the other questions, too, without my having to verbalize them.

This time, I only wrote a few questions and told myself, “Oh, he’s so good at explaining stuff, he’s sure to cover everything I want to know.”  He didn’t, and the more I think about it, I realize that someone else can’t very well answer my questions when I don’t even know what my questions are.

Whether it’s surgical options, or RA treatments, or anything else, I want solid information so that if things go wrong, I can look back in hind-sight and still believe that I made the right decision, regardless of which direction I eventually choose.  Give me the facts.