I don’t know if anyone out there remembers the William Hurt movie – yes, the one where after a humbling bout with cancer himself, the initially arrogant physician demands that his potentially equally arrogant students experience first-hand (so to speak) the invasive tests they will prescribe for their patients. OK… so I spoiled the end of the movie…it’s an old movie…live with it…
“The stool is black. So they were checking for… serious illness…”, said my worried patient, sitting opposite me, a veritable pharmacy of OTC pills for various ailments peeping out of his over-stuffed shirt pocket.
“They” didn’t check for Kalbeten or Pepto-Bismol, two drugs used for digestive disorders which contain Bismuth Subsalicylate, which has a side effect (info courtesy of the NIH’s Medline Drugs) of darkening the tongue and stool.
All this didn’t help my erstwhile patient, who had been the rounds of every invasive test known to man and demon in the investigation of the black…(if you’ll excuse me…as a dear departed friend used to say before saying any slightly questionable word)…poo. And if modern medicine has proven expertise – apart from emergency medicine which has veritably turned science fiction into fact in its incredible advances – it is in the devising of the invasive, preferably humiliating, test, especially where digestive issues are concerned.
I have never understood why people are so willing to put themselves under the knife, into the x-ray booth, have tubes poked into every orifice, have substances injected into them, swallow some of the most noxious beverages known to man, follow instructions not to eat/urinate/propagate – without asking simple questions such as “why, exactly, do I have to do this?”
Why are we all so willing to be examined by machines in dark rooms, in metal tunnels, when the medical personnel involved basically tell us “I’m injecting you with this. There may be side effects…sign here. What side effects…? Oh, you might die… but not if you eat fish…” (yes, that one is a true story). Who has not experienced the truly trust and confidence enhancing (I lie… but perhaps you guessed…) experience of being prepped by staff for these tests, being told to hold still, and witnessing the staff fleeing for their lives to observe the process behind metal and glass while we face the (inevitably) grey, metal monster…alone…
Ken Murray, himself a physician, recently wrote in the Wall Street Journal that in the context of terminal illness many doctors choose the path of less treatment than the average American. Less treatment than that requested, often demanded by the patient, less treatment than that prescribed, often aggressively, by the doctor. They even provide for final moments. “They know, for instance, that they don’t want someone breaking their ribs by performing cardiopulmonary resuscitation (which is what happens when CPR is done right)”, states Murray. Did you know that? Did I know that?
What do I really think about this? (Well, you’ve read this far, I can only assume that you’d like to know…)
Sadly, many physicians must prescribe treatment in line with accepted protocols in order to ensure they won’t be sued for not prescribing… and many physicians don’t always agree with accepted protocols but are prevented from voicing their disagreement due to their totally understandable desire to keep their careers out of the (if you’ll excuse me…) toilet bowl.
None of this prevents you, the patient, from asking questions in the following vein (pun intended). And you will perhaps be surprised by how willing many doctors are to give you clear answers.
a. Is this test absolutely necessary?
b. How long can I wait before doing this test?
c. Will this test give any useful information that will lead to more effective treatment? Or will it just give a fancy title to the disease with no useful purpose whatsoever?
(A patient once suffered from sudden hearing loss after an airplane trip. After an expensive visit to a specialist and some invasive testing, the diagnosis came back. Perhaps you’ve already guessed. It was clearly a case of SHL… Sudden Hearing Loss…amazing how the capital letters make everything More Professional All Of A Sudden)
d. And one of the fanciest weapons in the arsenal – most health funds actually entitle you to a second opinion. Take advantage and hope you don’t land up with a doctor who is more focused on CYA than on your best interests. (What is CYA? I’ve exhausted my supply of “if you’ll excuse me” for today – use Google for heaven’s sake!)