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Can You Say No to Your Doctor?

“Thanks, Doc, But No Thanks”

I’ve recently had opportunity to decline medications recommended to me by two different doctors. Doing so once didn’t set off any triggers, but after the second time it occurred to me that maybe I ought to write something about it.

How often do we get to practice what we preach, after all, and maybe there’s something I can share that will help others question whether all they’re recommended by way of medical interventions is actually worth pursuing.

If you’ve read any of my other posts, you know I think we’re over-medicated and over-treated in America – and I’m not alone.

The reasons are obvious…

  • a payment scheme that encourages doctors to do more to us instead of for us,

  • physician over-reaction to malpractice risk, and

  • patients whose fears often outweigh their common sense (see “America’s Health Scare System“).

So I’m going to briefly outline my reasoning for saying “No, thanks” to two doctors, each of whom has covered their backsides by noting their recommendations in my medical record – laying responsibility on me if it turns out their advice should have been heeded. I’m fine with that.

“Sometimes the Right Thing Is Wrong”

First, however, a little context to demonstrate why my medical skepticism is more than an academic predisposition.

On my last visit to my primary care physician (PCP) some 18 months ago – my first with this new PCP – he renewed the sole prescription I’d been on for decades, but only for 30 days. He wasn’t comfortable with it, as it was an old medication with serious enough questions about its long-term safety that it’s no longer prescribed (I’m going to skip the particulars, as it’s only meant here as an example anyway).

So I was off to a specialist experienced with the suspect medication to oversee my phased withdrawal from it (it was dangerous to withdraw too quickly from one of the drug’s ingredients). This set off a bizarre series of withdrawal symptoms that mirrored the symptoms the medication itself might cause, but never had.

Instead, it’s been the withdrawal from the drug that’s triggered the symptoms the drug never did – and subsequent tests confirmed the feared damage from the medication never occurred (I was lucky on that count).

This is all considered rather odd – baffling  an array of eminently-qualified doctors in America’s medical mecca who’ve since been consulted about it. This makes me one of those dreaded “interesting cases” – medical-speak for they have no clue.

And that’s the point – there’s more of our medical treatment that’s rooted in such uncertainty than most of care to admit. The delusion of medical certainty is our preferred escape.

We like to think, for example,  we “beat cancer” when, if we’re lucky, it’s only in remission. The idea that we all – at least by a certain age – harbor cancerous and pre-cancerous cells isn’t something we fancy thinking about (see “Navigating Medical Nuance – Disease, Un-Ease and Uncertainty“).

This isn’t unique to you and me – it’s a form of cultural denial further encouraged by our blind faith in technological progress we hope, in our heart-of-hearts, will discover the key to eternal longevity before our number is called. Because as much as most of us believe in God and eternal life in some great hereafter, none of us are anxious to prove that belief correct.

Combined with a for-profit healthcare system (even when provided by “non-profits”) – unique to America among developed countries – this leads to exaggerated fears of death and too little fear of the damage many of our aggressive medical treatments can cause. We think it’s better to “take our medicine” without considering that the cure is often worse than the disease.

“Take My Wife, Please”

The old joke about “The operation was a success but the patient died” is far closer to the truth – to this day – than most of us are willing to acknowledge. And there’s way too much money being made perpetuating this cultural denial-cum-blindness to expect it to end anytime soon.

Indeed, merely raising the prospect of a more measured approach to medical interventions sets tongues wagging about medical “rationing” and “death panels”,  as if we’re all somehow entitled to every extreme measure known-to-man to keep us alive for as long as possible, even if it’s only artificially alive.

These are often the same ones complaining about others “taking” from them, while they’re happy to milk every exorbitantly-priced medical intervention at others’ expense. Hypocrisy knows no limits, especially when we think our lives are at stake.

But wait, what about my own medications that started this little rant? OK, we have the context of 18 months of intensive medical exams to figure out what the deal was with the medication I was withdrawing from, none of it of any value whatsoever – just an “interesting case”.

And now I’m back with my PCP for the first time since and he’s equally bewildered. Since he’s a younger chap, I thought I’d point out for future consideration that sometimes the right thing proves to be the wrong thing; I’d likely be far better off had I remained on that old medication and still free of these symptoms I’ll probably endure till my dying day, which is apt to come sooner now than it would otherwise.

Healthcare Isn’t Health

Which is why we shouldn’t confuse healthcare with health.

Yes, many Americans will benefit with the better access to healthcare they’ll have because of Obamacare. But many others will now be exposed to the same risks of over-treatment that the insured unwittingly endure already.

You’d think hundreds of thousands of needless deaths every year from poor medical care would cause more of a stir, maybe a little caution in our medical interactions.

But because it’s so well concealed, we remain all-too-anxious to follow doctors’ orders even when they may prove more harmful than helpful. One reason for this ready compliance – and “non-compliant” patients are considered a problem rather than a solution, by the way – is we seldom realize when we or a loved one is victimized by medical mistakes.

While the movement among providers to acknowledge such mistakes and apologize for them is gaining traction as a malpractice management tool, it still flies in the face of decades of professional denial and deception that won’t soon be overcome.

“So I Says to My Doctor…”

Once we were done commiserating about my mystery withdrawal symptoms, it was again suggested I consider taking a statin drug for mildly elevated total cholesterol, something I’d previously declined. The new logic invoked was the recent change in guidelines that suggest cholesterol-lowering statins for even more patients based, in my case, almost solely on age.

I pointed out that total cholesterol isn’t a reliable measure, that’s it’s even less important as we age – when cholesterol’s protective advantages may outweigh its downsides (unless your cholesterol’s highly elevated) – and that the evidence for statins among older folks isn’t compelling in the first place. After more cajoling, I told him to count me among the statin skeptics.

Subsequent lab tests revealed my HDL (“good”) cholesterol had increased significantly, which meant my ratio of good cholesterol to total cholesterol had improved (was more protective, as more HDL cholesterol is available to remove harmful excess LDL cholesterol, at least in theory).

This didn’t deter a follow-up note – you know, for the record – that he still recommended I consider taking a statin drug, God-love-him.

And Yet Again

My other “No thanks, doc” experience was a recent visit with one of the specialists enlisted to oversee my withdrawal from the suspect medication I’d been on for decades. Since that withdrawal had greatly exacerbated my neuropathic (nerve damage) pain and prior options had failed (one medication actually made it much worse), it was suggested I try Lyrica – commonly prescribed for diabetic nerve pain (not my source) and a celebrity drug barraging senior-hour TV ads (only here in America – most of the rest of the world doesn’t allow that B.S.).

Well, if you actually listen to the droning litany of possible side-effects, you’d think twice before taking it as well. In my case, some of those would further aggravate my other withdrawal symptoms, so I politely declined that one, too.

After we agreed there’s little that’s proven really effective for nerve pain – opioids, thankfully, are useless for it – I pointed out that nerve pain is one of the best-documented uses for medical marijuana, just to watch him squirm.

To my surprise, he didn’t totally eschew it and suggested I seek out a dispensary when they come on-line here in Massachusetts sometime later this year, but he wasn’t having anything to do with it himself (the state medical society is on record as opposing it because there’s insufficient evidence, unlike all the evidence, much of it negative, for the opioids they love to prescribe). I was pleased he at least didn’t want to go down the opioid rat hole with me.

So there you have it – my saga of well-intentioned, but wrong-headed, medical advice I chose to ignore. I did so not because of the cost of the medications, but because their risk-benefit ratio was – at least by my reckoning, and only for me – not a good one. I’d rather suck-it-up with the pain and avoid the probable downsides of these newly-prescribed medications.

Listen to YOUR Body

But that’s just me – in my unique circumstance. The calculus is different for each of us. The point here isn’t the specifics of my medication adventures – or “misadventures”, as they’re called in medical-speak (I do love the obfuscatory jargon) – but rather the role each of us can play in our own medical adventures.

It needn’t be the docile and unquestioningly compliant patient always following doctors’ orders to-a-T. It’s true that patient non-compliance is itself a problem in many instances – the hilarious depiction of Elaine Benis as such a non-complier in an old Seinfeld episode comes to mind.

But sometimes it’s simply that patients are listening to their bodies’ response to medications they’re prescribed. Many doctors are too quick to dismiss these responses and reach instead for another drug to counter the effects of the first drug causing new symptoms.

Much of this resides in their own culture of dismissing patient complaints because they don’t wish to consider their original prescription might not have been right for this particular patient’s unique biochemistry and genetic makeup. There’s no shame in that.

It’s mostly trial-and-error, after all.

Learn When to Say
“No, Thanks, Doc”

And there’s no shame in it when a patient says “No thanks, doc” – for the doctor or the patient. It’s how grown-ups interact with one another.

So be a grown-up in your medical interactions. The outcome is yours, not your doctors.

Maybe once patients learn to fear the risks of their treatments as much as their doctors fear malpractice lawsuits that causes them to over-treat their patients, we’ll achieve the balance we need for a saner – and more affordable – healthcare system.

John Lynch: John Lynch was founder and CEO of Medical Diagnostics, Inc. - twice named to Business Week's "Best Small Companies" in America. He's since founded MedSmart Members to publish consumer health education publications.
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