the 5 things I’d tell my patients if I had the time
There’s a lot that we don’t get to tell our patients. I would love to spend more than 15 minutes talking about ways to improve their live. Unfortunately we get pulling in a million different directions and it seems like we aren’t interested. We are interested its just that we have the next patient to see and the 15 minute time block is simply not enough to cover everything that we have to do.
This is a short list. It’s definitely not exhaustive, maybe I’ll write out more later but for now these are the top 5 things I’d like to tell my patients on any given day.
ONE
I would love to spend more time with you
I wish I could spend more time with my patients. While it may not seem like it, most physicians want to spend more time with their patients. Unfortunately there is too much to do and almost always a swath of nurses and patients that are pulling in different directions. Despite these pressures, we enjoy spending more than 10 minutes with our patients.
Unfortunately we’re very rushed because there are too many moving pieces preventing an efficient life in the hospital or clinic. Some patients need more time than others. Medicine is unpredictable. Patients with vague symptoms require more digging and testing. Emergencies happen. Patients show up late. Doctors show up late. Patients need more time to digest serious diagnoses. These all eat up our time and leave people impatiently waiting in the waiting room.
All of these situations happen on a daily basis. So if your physician is late seeing you, it’s probably one of these issues.
While we are a healthcare team, we don’t have as many back ups as a professional football team. If you want an expert in the field, you’ll have to be patient because everyone else wants that kind of expertise too. This leads to a lot of delays and we are collectively sorry. I’m trying to figure out solutions, but I’m getting more worried that there isn’t one.
TWO
The best doctors don't know
I've noticed a pattern amongst some of the smartest people I've worked with: they say, "I don't know." In a world where everyone on TV and social media claim to know how to fix the economy, healthcare, run the country, or fix foreign policy, I know it seems counterintuitive. Let me explain.
I've noticed that my mentors, often question, second guess, and doubt themselves, a lot. One study I wish they taught me in school and one that explains this phenomenon is the Dunning-Kruger curve - which is below.
As we see on the right side of the Dunning-Kruger curve, confidence drops sharply with more experience after the initial peak (labeled "Mount Stupid"). Often the experts seem to know the too many possible options and are able to sift through those options; that comes with a lot of doubt, questioning, and need to get more information.
Because of this, I tend to discount people that speak in absolutes; the people that are 100% sure (note that on the figure, the experts' confidence level doesn't go all the way up to 100%). As we learned in medical school, there are rarely absolutes. That being said, most people that says something is "proven" are lying.
As Annie Duke explains in her books How to Decide and Thinking in Bets (both very good books that compares decision making in life to decision making in poker), we rarely know anything for certain, but we can think in terms of odds and probabilities to be wrong less often. That's what we aim for in medicine.
As I often tell my patients, I can make no guarantees, but I can tell you what will most likely work.
THREE
We can't fix everything, even when we do "everything"
It’s seems obvious but some people think we can fix everything. We can’t. There is only so much we can do with 15 minutes. Medicines can only do so much, and most medicines are not cures, they’re just bandaids.
In my branch of medicine, we have very few actual cures. We give advice, recommend medicines, and delay death, but even the best heart doctor can’t fight against a diet full of Big Macs and super sized fries. The medicines you take once a day are no match for the fast food that people eat three times each day.
I don’t get to talk about lifestyle changes as much as I’d like to with my patients. Lifestyle changes are incredibly complex and have more to do with habits than real decisions. It’s difficult to get myself to change my habits, there is almost not way I can change someone else unless I spend a lot of time with them and they’re motivated to change.
Diets are hard I get it. I’ve failed most of my diets time and time again. I had a friend of mine that had a 5 vessel bypass surgery for his heart that happily refuses to change his diet or exercise habits. His story is not unique. There are a lot of patients saying the same thing. Change is hard, I get it. But medicines will not cure everything.
FOUR
Sometimes the simple treatments are the best
Medicines help. Medicines help more when they’re working with other good habits. Simple does not mean easy. Working on a healthy diet, exercise, losing weight, and quitting smoking contain huge benefits which work better than the medicines we prescribe.
We’re taught that the best thing someone can do for their help is to quit smoking. Based on the data this is true. While it’s easy to think that smoking here and there isn’t that bad, each time you smoke it increases your risk for illnesses and cancers. If you smoke and you have good health, it just means that you’ve beaten the odds — not that smoking isn’t bad.
The best way to treat lung cancer is to not get it. That starts with avoiding smoking.
I had a patient recently refuse treatment for sleep apnea. This is not unusual as many people find it hard to sleep with a breathing mask strapped to their face. A continuous positive airway pressure (CPAP) machine keeps patients’ windpipes open during sleep if they have obstructive sleep apnea (OSA). The machine is loud and makes it difficult to sleep. Unfortunately the treatment is important as OSA causes many complications if left untreated:
high blood pressure
atrial fibrillation
pulmonary hypertension
difficulties with medical procedures requiring anesthesia
daytime sleepiness and fatigue
The main risk factor for OSA is being overweight. Therefore, one of the best ways to avoid the need for a breathing machine while you sleep (CPAP) is to lose weight. It’s a simple remedy requiring little technology, but it fixes the problem at the source. The CPAP is a bandaid that doesn’t actually solve the underlying issue.
This is not to say that there may be certain genetic factors for OSA but that obesity is one of the main contributors.
FIVE
Keep track of your own health
A close second best thing you can do for your health is to keep track of everything you can with your health. It’s so much easier now more than ever to quickly jot down or type a quick note. Write down what the doctor tells you. Keep a tracker of when you’ve taken your meds. Ask for copies of the notes that doctors write about you so you know the exact terminology.
Our electronic medical records system is full of faults and a big one I that not all of our records systems talks to each other. This means that we often rely on patients to know what’s going on with their health.
We often see patients from different countries where doctors in their home country did something, but the patient doesn’t remember the exact terminology. This leaves the physician guessing what the other doctor was thinking — not a great system.
A few weeks ago, a patient of mine had this exact scenario. Luckily she brought in the documents from her hospitalization outside of the U.S. which made our job exponentially easier! We knew exactly what was done and what needed to be done.
I applaud the patients that come to clinic with notebooks full of lab values, hospital records, blood pressure readings, and iwatch EKGs. Not only do these tidbits of information make my life easier, they show me that the patient is invested in their health. Few things are more frustrating than someone that doesn’t really care about their health.
I really wish I had more time with my patients, unfortunately I don’t think that will happen any time soon. So this list will have to suffice. I’m hoping to provide more patient education stuff like this in the future. Let me know what you think below!