Thursday, May 15, 2008

Listen Up, Doc!


In the beginning, I hated confronting my rheumatologist (Dr. R). I wasn’t afraid of him as much as I was the answers he had to give me. I worried about articulating all of the questions swirling around in my head, and feared the onslaught of tears that came so readily during those first few months.

About six months after I started seeing him, I felt that I had hit a plateau. I was still very sick and didn’t seem to be making much progress. My family prompted me to seek a second opinion, but I had to tell Dr. R first so that my charts could be released. It may sound like a straightforward, uncomplicated thing to do, but I was terrified. I had to tell the one person who had been my greatest advocate that after all he’d done to help me, I didn’t think it was enough. I felt like a traitor, and didn’t think I was strong enough (mentally or physically) to go through with it.

When I finally broached the subject with him, he responded professionally and amicably, much to my relief. I explained how I thought it might be a good idea for me to see another reputable Lupus doctor my family had read up on. He immediately thought it was a good idea that ‘we’ get a second opinion, instantly sharing the burden and making it seem as though it was necessary to do so. In fact, he was so agreeable that he suggested that instead of seeking the help of the physician I’d suggested who, he thought, roughly had the same qualifications that he did, we should set up an appointment at the National Institutes of Health with a specialist in the field. It seemed he wanted answers just as badly as I did, making me realize that had I never questioned the progress we were making, he might never have seen fit to suggest another alternative.

He promptly prepared the necessary documentation and made the appropriate phone calls, and within days I was at NIH, where I underwent a thorough series of tests and examinations. The doctor I saw at NIH followed up with me several times over a period of two months, concluding that my care under Dr. R thus far had been customary, appropriate, and more than sufficient. It seemed Dr. R was doing everything right; Lupus just wasn't responding.

I returned to Dr. R’s permanent care, confident now that he was doing all he could, but worried that I had offended him with my insistence to see someone else. I thought my betrayal might have tarnished our doctor-patient relationship, but to the contrary, it seemed to have strengthened it. He now saw me as a patient who meant business: someone who was straightforward and honest, self-assured and independent. I was a patient who wanted to take responsibility for my health, not just accept his advice and guidance without dispute.

The greatest change didn’t come from him, though; it came from me. After I witnessed his response to and the results of my polite, yet firm confrontation, I began to see myself in a whole new light. I proved that I could be forthright, confident, and definitive, even in a subject where my counterpart had the advantage. It was the first time I had taken the future of my health in my own hands, and it felt good. I had renewed my self-respect while earning my doctor’s, helping our doctor-patient relationship to thrive.

Since then, I’ve exhibited my assertiveness time and again with my doctor, realizing now that he expects nothing less from me. There have been times when he’s seemed distracted or impatient, dismissing a symptom I’m concerned about or glossing over an issue too quickly. I take a moment to realize that he, too, is entitled to be a little “assertive”, and that I’m just as responsible for keeping the relationship afloat as he is. I try rephrasing the question or readdressing the issue in another manner or at a more appropriate time. Note that I never sacrifice my expectations; I just learn to compromise on my approach in order to get what I need. Assertiveness isn’t about brawn or brute force; instead it’s about diplomatically displaying a self-confidence that cannot be ignored. In my opinion, it works every time.

Over the course of the next few weeks, I'll share some of my "Listen Up, Doc" tricks that are mentioned in my book, "Despite Lupus". A productive and beneficial doctor-patient relationship has done wonders for me; hopefully, it can do the same for you.

2 comments:

LFA said...

hey there ... my name is Wick Davis and I'm with the Lupus Foundation of America. I came across your blog and wanted to say hi. I'm in the process of reaching out to other lupus bloggers. I was wondering if you'd be interested in exchanging links to one another's blog. You can read the LFA blog here http://lfa-inc.blogspot.com. I would love to talk more with you. You can reach me at davis@lupus.org. I hope to hear from you. best, Wick

Katie said...

Great insight into a physician/patient rapport.
That is useful advice for any patient.