Should you ever not listen to your doctor?

Since I got married seven years ago and had two kids, I’ve had to shed parts of my life, like the hockey package, going to the movies, and slow-pitch softball. None were hard sacrifices, but the casualty that hurt the most was giving up my doctor of over 20 years. I met him soon after I got out of college and he was early in his career, and while I never needed him for much, I knew he was on top of everything.

Even after my wife and I moved north of Boston, I wanted to believe that I could keep him, that an hour-long drive into town without traffic was possible, because how often did I ever have an emergency? Well, in 2014, one month into our first year of preschool, my son got hand, foot, and mouth disease, and then I got it. After a walk-in clinic visit, the breakup process began.

I got a recommendation and met a new guy. He was nice, competent, and gave ample time on the first appointment. He also wanted to prescribe a low-level statin for some elevated cholesterol. I was 47 years old, active, in good shape, had never had high cholesterol, and had no interest in being on regular medication. He said I could retest. I did several months later and my numbers went back down. I was happy, but also wary. If I had complied, I’d probably still be on the drug. When I asked for his rationale at our second appointment a year later, I wasn’t satisfied. I felt I got lumped into a large group of “what people usually do.” I now had doubt.

And there was another thing that added to it: he wasn’t in the best shape. It was a complete nonissue at first. I wasn’t looking to a doctor for fitness advice, but after the statin conversation, I wondered if I could take long-term health advice from someone who didn’t look so healthy. So, I asked Charles Morris, M.D., associate chief medical officer at Brigham and Women’s Hospital, if I had cause.

Based on the doctor’s apparent shape, no. And I knew that. There’s no correlation between belt size and skill. On being depersonalized, yes, there was a valid concern. “You want to feel like the doctor’s advice was tailored to you and not just people like you,” Morris says.

But this brought up some bigger questions. Medical care feels more restricted, more expensive, and time feels increasingly rushed, so, in this dynamic, what’s reasonable to expect? What should you find out, and what should be in place from the start to let an otherwise healthy person know that this is the right doctor for the long term? Morris has some ideas:

• Family history. It’s routine with the initial exam, but it’s more than checking off boxes. It should involve the doctor asking whether your parents are alive; if not, how old they were when they died; and what conditions your parents and siblings have been treated for on a regular basis. All this information hints at what you’re at higher risk for, and depending on the answers it can set an earlier and more focused timeline for screenings.
• Ask what the doctor’s team looks like. Everyone wants to be able to reach their PCP directly on all occasions, but that’s not happening — there just isn’t time. It is realistic to ask who you should follow up with, and who will be getting back to you and when. Offices have a triage system, and in general, non-urgent matters should get a return call within 24 hours.
• You should be asked something like, “If you had free time, how would you spend it?” The doctor wants to see what, if any, outlets you have and whether you’d rather hit a bar or go skiing. If there’s concern, a doctor should be trying to guide your habits when life is less complicated, so you’re not digging out of a hole in your 40s. And related to that, there’s the issue of…
• Mental health. The free time question touches on how happy or full your life is. Another tool that doctors use is the first two questions from the Patient Health Questionnaire. Over the last two weeks, how often have you been bothered by: 1. having little interest in doing things? 2. feeling down, depressed, or hopeless? It’s not all-encompassing, but it gets at how prevalent depression might be.
• At the beginning of every appointment, there should be an exchange that goes something like, “I have things I want to cover. So do you. Let me hear your list and we’ll prioritize the top eight.” You’re a team. The agenda should be mutual, and ensures you get time to be heard.
• You can push back on anything. If something doesn’t feel right, ask, “How am I different from other people in that category? Is there anything I can do to change that recommendation?” Again, it goes back to getting tailored advice and ultimately feeling like the doctor gets you. If you don’t feel comfortable asking questions, you’re in the wrong office.

The post Should you ever not listen to your doctor? appeared first on Harvard Health Blog.

From: Steve Calechman https://www.health.harvard.edu/blog/should-you-ever-not-listen-to-your-doctor-2017122612959