July 10, 2008 - Loss of Control

A friend of ours, Mary Beth, sent me a link to a doctor’s blog, “Musings of a Distractible Mind,” by Dr. Rob, an internal medicine doctor from the Southeastern U.S. It’s an insightful and witty blog – well worth a visit.

I was interested in a post, “Dangerous Information,” from June 25th. In it, Dr. Rob engages in a good-natured rant about patients who habitually question the prescriptions he writes:

“A patient left me a message earlier this week: ‘I was reading the information on the drug that Dr. Rob prescribed, and I am really worried about it.’ He went on to say he was faxing me the prescribing information, just in case I didn’t realize the risk of the medication.

I hate it when people do this. Do they realize that I studied for eight years and have practiced another thirteen? Why would I prescribe something for them that I don’t know about? Why would I put my name behind a ‘dangerous’ prescription? Why would they bother coming to me if they thought I did not know these things?

I don’t really take it as a personal insult, and I do feel that it is fine to question the doctor. I am sure it has happened that I have given prescriptions with interactions and/or side effects that I did not think of, but there are some levels of questioning that cross the line. I am an internal medicine doctor, so medications are my tool. Would you ask a surgeon, ‘Are you sure you should make a midline incision? Do you think that a lateral approach may be better?’ Do you tell a cardiologist, ‘I read on the Internet that the non drug-eluting stents are better than the drug-eluting ones’? Do you ask the radiologist, ‘Don’t you think that density could represent pleural plaque rather than an infiltrate?’ Probably not.”

I posted this comment in Dr. Rob’s blog:

I’m not sure most patients who question doctors’ prescriptions do so because they don’t trust the doctors. I think they do it for the same reason so many people are obsessed finding that miracle food (or avoiding that dangerous food) they imagine will prevent cancer. It has to do with loss of control.

Unlike submitting to a surgeon’s decision on where to place the scalpel, popping a pill into our mouths is something we do have some small measure of control over. And so, some of us hang onto that tiny shred of control, even if it makes our doctors suspect, sometimes, we have no confidence in them.

A great many illnesses happen regardless of how we choose to live our lives: and that truth is a hard one to absorb. We like to imagine the world is a fundamentally safe place for people who work hard and try to do the right thing, when in fact it’s not. Bad things do happen to good people. Most of us would rather cling to the illusion that we are masters of our own destinies.

I've got non-Hodgkin lymphoma, a disease for which there are few known environmental or inherited causes. Some unlucky people just get NHL, and medical science doesn’t know why. A cancer like mesothelioma isn't like that. Most cases of that disease, I've read, result from asbestos exposure. Luck has nothing to do with it (unless you count the decision to take a job in an insulation factory in the 1960s a matter of bad luck). The same goes for people with leukemia who were living downwind from Chernobyl when that nuclear power plant melted down. A person with asbestos-related or radiation-related cancer knows exactly where it came from. And there’s some small - admittedly, VERY small - comfort in that.

So, next time one of your patients brings in some article from a wacky natural-health magazine about the benefits of some cactus extract, or starts questioning whether the prescription you’ve prescribed safely for hundreds of patients could make them sicker, consider this: it may be because your patient is struggling to absorb the harsh truth that some sickness just happens.

Cancer is a scary thing. That’s why the field of cancer treatment is a congenial playground for all manner of charlatans and quacks – and why so many cancer patients are so easily bamboozled by them. Yes, it’s a very good thing for us to educate ourselves, becoming as well-informed as we possibly can. Yet, let us also remember, as we scan the Internet, that doctors who have studied long and hard to learn about our condition are our best, most trustworthy advisors.

Thanks, Mary Beth, for the link to this excellent blog. And thanks, Dr. Rob, for getting me thinking about this.