TO THE NICE NONCOMPLIANT LADY (MAN)

Many years ago, as a much younger physician, I’d bristle when you’d share with me on follow-up visits that, having consulted Dr. Google, you decided to take the medicine every other day, or that you took a lower dose, or more seriously, that you didn’t think you needed the medication at all – all the time remaining silent and, with all due respect, not caring to call and share your concerns. That was years ago, the bristling. But now I’ve come to realize that in this Age of Empowerment that people have as much a right to shoot themselves in the foot as they do to submit to professional medical advice.

But it’s discouraging to see the doctor-patient relationship sometimes morph dysfunctional as a result of the information-sharing transaction, so integral to the endeavor, lacking completeness.

It’s disconcerting to see people pay for professional medical advice and then while harboring doubts about a clinical judgment, remain silent – not that any doctor’s clinical judgment is above reproach, or for that matter, always accurate. But in not expressing one’s doubt to their doctor one fails to take advantage of learning something new, if not about your health condition, perhaps about you yourself, a singular benefit to anyone in a doctor-patient relationship.

As we all know, we are living (swimming) in a sea of information -- the Information Ocean -- and like swimming in any ocean it can be both perplexing and exhilarating. But it can also be a cause of noncompliance, when it doesn’t have to be. The ever-present endorsement by Dr. Google to become an empowered patient is, at heart, a good thing, for as they say knowledge is power – unless, of course, you choose to exercise your knowledge in a tyrannical fashion, and not as a means to facilitate the process whereby an accurate diagnosis and treatment plan can be expeditiously arrived at -- all to your benefit. The doctor-patient relationship only operates to your benefit if there’s a vigorous and authentic exchange of information. And more so if it’s based on trust, as it should be.

Now don’t get me wrong. I’m not totally against Dr. Google. You may recall how during your office visits while in the exam room, using my Smartphone, I showed you a picture, diagram, or article, to reassure or convince a doubting mind that what I was advising was in fact the “real deal”. Or sometimes I’ve referred you to one of Dr. Google’s articles. So indeed Dr. Google has his place.

And I realize from time to time you may hear from, usually young, crackerjack journalists about how “all these doctors are putting people on all these medications.” But know that these newspaper types who write and talk like this are unaware of your particular situation, your particular condition, and your particular needs, and are really wily wordsmiths, buccaneers in journalist costumes, who themselves probably take no medications, thinking they’re 10-feet tall and bullet proof, and riding on their high horses proselytize their inane gospel of “get rid of all the medicines.” Typically, they promote the “all natural” philosophy. But be careful as you read their print as one day they too will be eating their words, glad to have prescription medicine that alleviates their failing heart, wheezing lungs, high blood pressure, and as the case may be, their chronic prolapsing hemorrhoids that may be screaming “take me out!”

Now I would also be remiss if I didn’t mention too your penchant for not infrequently complaining that you “are on too many medications”, regardless of the number of medicines you take, be it 3, 6, or 13. So you take it upon yourself to hold off on a few. Admittedly, as time goes on medication adjustments are sometimes necessary. But as you may recall, on each occasion when I ask how many medications you yourself think you need to be taking you’re at a loss for an answer, saying something like, “I don‘t know. You‘re the doctor!” So we proceed down the medication list, one by one – this one’s for cholesterol, this one’s for blood pressure, this one’s for fluid retention, and so forth – and at the end of the list, being given the choice of discontinuing any medication, you end up choosing to take them all. At least this process is healthy insofar as bringing to your doctor’s attention your concern. Better than remaining silent about it or to make self-directed adjustments without the doctor’s knowledge.

And while the notion of noncompliance is about not following or complying with instructions, it’s important to point out a more prospective problem that you’ve been complicit in. And that is vendoring the doctor, in which your position during the visit is “I’m paying the doctor his fee so I should be able to buy what I want.” In the business, we call this “prostituting the profession.” And it’s an attitude or policy that can be dangerous for both of us. Some doctors, I‘m sorry to admit, couldn‘t care less about it, interested more in servicing dollars than servicing their patient’s true interests and needs. But making demands for particular tests, x-rays, procedures and so forth can be discomfiting to both patient and doctor. So try not to treat your doctor as a vendor; try your best not to seduce him in to prostituting his profession.

So in conclusion, know that our relationship is a special one, and one that I even consider, at the risk of sounding mushy, special.  Our visits have one overriding concern: and that’s to benefit you. So as I mentioned before, it’s good to be informed and to ask questions. Because only through vigorous communication and a trustworthy and authentic exchange will our visits truly be to your optimum benefit. And if your empowerment causes you to truly think otherwise, then the least common denominator in all of it is that we can still be friends.

Yours in good health,