Regular readers will know that I’m a fan of active engagement in our health-related decisions. To do this effectively, it helps to know several things about the healthcare system. This understanding will relieve your frustration with the way things are, and it may also make you more empathetic toward the doctor who doesn’t listen when you try to participate.
1. The healthcare system is a product of the consumer culture, and is designed around money.
Doctors are paid for a very short appointment time with each patient, usually about 10 minutes. That means appointments are booked close together and the doctor is invariably running late by the time the first patient leaves.
From the patient point of view, this means a long wait after arriving at your scheduled time. It also means your doctor may seem rushed, harried, and unwilling to listen to your explanation of what’s going on with your health. And, if you have the impression that doctors only want to hear about one issue at the appointment, that’s true. Ten minutes doesn’t allow enough time to sort out even one problem, never mind a complex health issue.
- Take a book, listen to your iPod, or decide to enjoy leafing through magazines you don’t normally read.
- Book your appointment far enough in advance so that you can get the first slot in the morning or after lunch.
- Don’t plan your next activity for the day based on the time you would be free if you got in to see the doctor as scheduled. You know it isn’t going to happen, so be realistic and save yourself the stress.
2. Physicians are the product of a system that has trained them to think a certain way.
Conventional medicine is based on the fix-it principle: diagnose (i.e. label) the condition and prescribe something to relieve symptoms. Conventionally trained physicians do some things very well. They are the people you want when you have a medical emergency. They know how to swing into action to stop bleeding, stitch up wounds, fix broken bones no matter how severe the damage, and generally put Humpty Dumpty back together again. They also have access to state-of-the-art equipment to do advanced tests and complicated procedures.
But it’s another story when you have a chronic illness. Their abilities to put you back together don’t help when lifestyle changes are the best prescription. Sadly, there are major gaps in conventional medical training. Unless doctors have taken extra courses, they know next to nothing about nutrition. When it comes to exercise, they wouldn’t know what to recommend beyond the basics unless they have studied it for themselves. When you have a crick in your neck, they can give you something for the pain, but they aren’t trained in how to adjust your spine.
In essence, medical doctors have been schooled to see health issues as individual problems that require medicine to get rid of the symptoms. They do not have holistic training that looks at the function of body systems and how they interact with each other.
Conventional doctors are schooled in using pharmaceuticals but not herbals, homeopathics, or other forms of more gentle treatment. The cynical part of me would refer back to point #1 about the monetary basis of healthcare. Pharmaceutical companies have huge amounts of profit at stake and put a lot of attention on promoting their products to both patients and doctors. They position pharmaceutical drugs as the only solution to health problems.
- Be clear about your health biases and preferences. This helps you find the most suitable practitioners for you. For example, if you prefer prescription drugs only as a last resort, ask questions to find out if that is your doctor’s philosophy. If it isn’t, you can decide how you’ll manage that with your doctor or if you’ll look for another who’s a better match. It’s not a question of right or wrong, but whether there’s a fit or not.
- Assemble a team of practitioners. A family physician is a must. He or she has a unique knowledge base, is able to prescribe pharmaceuticals if you need them, and is your access to the system including hospitals and labs. Other possibilities for your team include a medical doctor with functional training, a naturopathic doctor, Ayurvedic doctor, chiropractor, nutritionist, physiotherapist, Chinese medicine doctor, acupuncturist, massage therapist, psychologist, and energy practitioner.
- Seek out practitioners before you are in a health crisis, if possible. Consult friends with similar values and preferences for recommendations. You can also find on-line reviews in some cases.
- Arrange for an introductory meeting. My current GP booked a “meet and greet” appointment with me when I enquired about becoming a patient in her practice. These days there is more emphasis on the patient-doctor relationship. I think it’s fair on both sides to meet before diving in so there is the space to develop rapport.
3. Your doctor is confined by the system – e.g. office policies and constraints of the insurance plan that covers your care.
This system can be a brutal workplace for your doctor. In the following video, a family physician shares her experience. This was filmed at Dr. Pamela Wible’s physician retreat. Pamela Wible is a medical doctor who has humanized her medical practice and is on a mission to reduce physician suicide. For more, check out her TED talks.
This doctor is not alone in her experience. In 2014, Atlantic Magazine investigated the issue of disillusioned doctors. According to “Doctors Tell All—and It’s Bad”
…students (like the doctors they will become) are overworked and overtired, and they realize that there is too much work to be done in too little time. And because the medical-education system largely ignores the emotional side of health care…doctors end up distancing themselves unthinkingly from what they are seeing.