A doctor offers five things she wants her patients to know
This marks a year since I began writing The Washington Post’s Ask A Doctor column and what a privilege it has been. But I’ve been doing more than dishing advice. I’ve also been listening — reading your comments, getting emails and talking to my patients.
What I’ve learned is that the science is only the bare bones of the story. Your lived experience is the heart. After reflecting on what I’ve heard this year, these are five things I want my patients to know.
1. Our health isn’t all determined by the big moments
Preventive health comes down to the innumerable micro-decisions each of us makes every day. Bacon at breakfast may be another inconsequential food in your week, while a lifetime of eating processed meats can tip the scales between colon cancer and health.
Those smaller moments can have a butterfly effect you can’t always foresee. One patient of mine agreed to adopt his relative’s dog three years ago — mainly because he felt lonely and wanted companionship. Despite being a self-described “couch potato,” he’s since been easily hitting the recommended physical activity guidelines every week because he started taking his dog for runs around the neighborhood. In addition to the mental health benefits, he’s no longer prediabetic.
How would his trajectory have been different if he had never adopted a pet, if he had hired a dog walking service instead or decided to play fetch instead of joining his dog on a run?
Where would his health be in 10 years if he had developed diabetes?
Our tiny daily decisions add up. Healthy choices made even some of the time are better than unhealthy choices made all of the time.
2. Everyone is frustrated with doctor’s appointments.
A recurring theme I heard (and lived) this year was about how doctors are always running late. These frustrations drive your physician nuts, too.
The roots of the problem trace back to the early 1990s when Medicare assigned a relative value unit to primary care appointments of the equivalent of 15 minutes. Private health insurers quickly followed suit, and so to sustain themselves, clinic administrations jam-packed their physicians’ schedules. Those overflowing clinics racing to meet the demands of insurance companies are loathed by doctors and patients.
Here are two tips to maximize time with your doctor:
Come 15 minutes early to your visit. That means, you’re checked in, paperwork is filled out and vitals are checked, so that when your appointment officially starts, you spend more of your allotted time face-to-face with your physician and not getting your height measured.
Plan your story ahead. Lead with your most pressing problem and get the timeline of your symptoms straight with as many specifics as possible (it makes a big difference to your doctor if your cough has been going on for several months instead of for two weeks).
3. Don’t be afraid to talk about embarrassing health issues
The semantics of our bowel habits were an unexpectedly steaming hot subject of debate among my readers. Some weren’t sure if it was even okay to say “poop” aloud. (For the love of bidets, yes, I give you permission). I perform colonoscopies every week, so believe me when I say that words such as flatulence or farting won’t make me blush.
More importantly, don’t let embarrassment keep you from getting the help you need.
For example, as many as 80 percent of people on an SSRI, a kind of antidepressant, experience sexual dysfunction as a side effect, but about half of people who stop their SSRI for this reason don’t discuss why with their physicians. If you tell us the real reason, we can do a better job of trying to help you.
4. Talk to your family members about their medical history
Many of my patients don’t know what their grandparents died of, if their brother has an autoimmune condition or how old their uncle was when he was diagnosed with cancer. These details affect how your doctor thinks about the right tests for you.
For instance, if you knew that your aunt and grandmother both had breast cancer diagnosed in their 40s, your doctor may recommend you undergo genetic testing for breast and ovarian cancer. But if you didn’t know about your aunt’s history because no one talked about it, and you weren’t sure how old your grandmother was when diagnosed, it’s possible your doctor would just recommend regular mammograms.
Talking about our medical problems can feel uncomfortable. But explain that it’s important for your health and that of other loved ones in the family to know.
5. Your doctor is cheering for you
Literally. When I see pathology results come back showing one of my patients is cancer-free, I cheer out loud — yes, by myself, in front of my computer. My co-residents and I used to high-five when we saw a patient’s hemoglobin A1C — a measure of glucose control — come down after months of making adjustments in our primary care clinic. We’ve been known to do a happy dance in the hospital call rooms when patients get offered a lifesaving organ transplant.
Medicine is a team sport. Patients don’t always see what happens behind the curtains, but your wins are the very best parts of our day.
