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Patient responsibility: At what point does the public at large finally decide that they hold the golden key to health?

Posted by Administrator on Nov 18 2014
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Written by Ken Armstrong on November 10, 2014 for CanadianHealthcareNetwork.ca

The patient is the one with the disease: Rule #4—Dr. Samuel Shem in The House of God

What the hell have doctors got themselves into? I mean, really. Ever since our time in the hallowed halls of medical school, we have had deeply ingrained into our intellect

  • the responsibility of learning the vast knowledge base required for the world of medicine
  • the responsibility for assessing and then treating sick patients
  • the responsibility of charting properly, the responsibility of “being in charge” of the healthcare team
  • the responsibility of keeping up with continuing medical education, and
  • the responsibility of not making the college angry (for whatever reason).

Well, I’ve got news for you. I learned about responsibility long before medicine came into my life. When I was a child, anytime something was broken or missing, my mother would say, “Ken, you’re responsible.” Thanks, ma.

When it comes to medicine, I am getting maxed out in the guilt that is being thrown around when a patient gets sick or dies, and it is time to throw it back where it belongs: in the lap of the patient.

I remember a case when I practiced family medicine where a patient was diagnosed with lung cancer. Smoking was a big part of that patient’s history and, surprise, he developed a cough. With appropriate investigations a year later (he didn’t come back in for reassessment), it was found that this individual had lung cancer. On the visit where I had to break the terrible news, the patient said threateningly, “How come you didn’t do a chest X-ray when I first came in, doc?” (I hate being called doc.)

I looked at the notes from that particular visit and I replied, “Oh, I did want to do an X-ray but you refused. Would you like to read my notes?” The patient was still smoking.

I also remember a pharmaceutical ad from a publication with a pseudo-mirror on the page and under it was the caption, “Look who’s responsible for getting the patient’s blood pressure under control.” I bet there were a lot of doctors who started sweating a little bit after seeing that one.

So we have patients, their families and pharmaceutical companies who are more than happy to feed into our egocentric attitudes with their visits and then prey upon our narcissistic professional selves in order to have us prescribe whatever drugs that make us, as physicians, feel better. Whether it helps the patient in front of you is a different matter.

It is well-known that 90% to 95% of the cancers that we suffer from are self-induced. Yup—smoking, eating fatty foods, obesity and excessive sun exposure for starters. How about the causes of heart disease? Got an hour to list them? Most of them do not come via the physician and his or her treatment. Type 2 diabetes is primarily obesity via diet, lack of exercise, etc. We all know the risk factors; I checked Google: Doctors aren’t on the list.

When you look at the Stats Canada website for the top killers for any age (2009 only, though—Stats Canada isn’t as expeditious with their statistics as the United States), you will see that cancer, heart disease, accidents (which usually means motor vehicle accidents) are quite prevalent, with cancer now surpassing cardiovascular disease as the most dominant.

At what point does the public finally decide that it holds the golden key to health? When do patients decide that maybe changing their habits and vices will provide a huge change in the quantity and quality of life, instead of pointing their finger at the doctor? For some reason unbeknownst to me, patients feel that physicians are not worth listening to (save Dr. Oz in his greens), and that doctors lack the knowledge to cure them so patients return to all their bad habits.

Physicians, take your own pulse and realize that you are doing everything in your power for these patients but you may be going overboard in blaming yourself when things go wrong. The patient is the one with the disease.
Patients should be held accountable for the decisions they knowingly make that affect their health (and incur health costs), and let you, their physician, go home to your family with the knowledge that you did everything you possibly could in your capacity as their medical adviser. We don’t have the ultimate controlling hand—the patient does. It’s their deal now.

Ken Armstrong is an occupational health physician in Oakville, Ont.



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