Since the idea of 18 Seconds began, I have focused on the idea that doctors are able to spend a limited amount of time with each patient. Physicians are pressured by circumstance to hurry; we are pressured to see as many people as possible, in order to meet our financial obligations. I hope we can agree that communication suffers in this scenario.
But, a recent article that I read made me think about the unfortunate truth that a patient spends very little time thinking about who is advising them?
The article I read is by Frederick Gandolfo, MD and focuses on the omniscient white coat and how it does not mean much anymore. “Anyone can wear a white coat,” is an opinion that’s thrown around medicine these days — and it’s true! Nurses, physician assistants, lab techs and patient care managers (who are administrators) all wear white coats. At my facility, because of past patients leaving the hospital complaining that they never saw a physician, we now have a the label of “DOCTOR” in red added to our name badge.
As a patient, it’s important to know who you are receiving advice from, and I don’t mean just that they need to be a doctor.
You must also consider: what is their background, what may be their motives? Remember, we are all human, even the ones in the white coats. We are all subject to the needs, wants and frailties of the species. We all want to believe that a white coat would never prescribe something, whether a medication or test, based on his or her own needs or fears. Unfortunately, it happens. According to Jerome Groopman, MD in his book, “How Doctor’s Think”, cognition and emotion are inseparable. In other words, our feelings and how we think are inseparable.
What does this mean for you? Think of the last time you were tired; I mean really tired. Think how difficult it was for you to make decisions, even easy ones, like what to have for dinner. You probably stopped on the way home and got something that made you feel happy; for me, that’s something fried or sweet. When I am not tired, I think through my dinner decision and will generally go with something healthier, or I might even go to yoga first, then have a light something after! Tiredness is definitely an emotion or condition that affects our way of thinking.
Another example: think of a time when you wanted to start something, like a better diet or to start exercising. At first, the decision to continue (to do the thing): eat better, take more walks, run…whatever it is, happens fairly easily. You just do it. Then, life sets in: work is more stressful, your spouse is getting on your nerves, and decisions become a lot more difficult. It is harder to continue on that set path. It’s not necessarily your willpower that has failed you, but your ability to make that tough choice. The path of least resistance may be the sofa and a glass of wine.
Most errors are mistakes in thinking.
Part of what causes these errors is our inner feelings. Feelings we do not readily admit to and often don’t even recognize. None of the above examples are life and death decisions, at least not immediately. They generally don’t cost a lot in the short term. Now, think about your doctor. Think about how many decisions he or she has to make each day. Not just the ones about patients, but the ones about her own life, too. In other words, if your doctor is having a bad day, is extremely tired, has had a challenge with her child, or some other decision-making stresser, your chances of a mistake (at worst) or unnecessary testing (at best) increase significantly.
Please understand that none of this is intentional. Remember mistakes in thinking are the cause of most errors, not just medical errors, but all errors. Why do we have mistakes in thinking? It could be due to lack of information, but even that is generally due to a thinking mistake. Most of us want all of the information when we make a decision, right? So when we make a decision, we think we have all of the information we need. We can make these mistakes for a lot of reasons, not the least of which is emotions. Again, these are likely emotions that we do not even recognize that we have.
OK, so what can you do about this? You can go into your meeting with your doctor ready to listen and ask questions; think about what is best for you after considering the information that you are given. I realize that most of us go to the doctor when we are not at our best. This is why it is a good idea to take someone with you. Take someone that you trust; someone who has your best interest in mind. Take someone who is feeling well and thinking clearly. They can listen to you and listen to the doctor as you have your conversation. They can help to correct what they may see as misunderstandings during the conversation and review what they understood when you are back at home and possibly wondering what just happened.
Remember, your health is your responsibility.
