Friday, January 29, 2010


When I asked a friend, “How are you?” she answered, “I don’t know. I don’t see the doctor till Tuesday.”

She happens to be from a generation older than mine. In her day, the word “assertive” hadn’t yet been coined. Your doctor told you what was what and you didn’t ask questions. The relationship was unquestionably vertical, but thankfully it didn’t stay that way. I mentioned in an earlier blog entry pediatrician Robert S. Mendelsohn’s comment his 1991 book Confessions of a Medical Heretic, “We physicians will come down off our pedestals as soon as patients get up off their knees.” 

Sure enough, that has come to pass. Patients gradually stood their full height and insisted on partnering in their healthcare. But to do so required a little work, mainly in becoming knowledgeable. It’s normal these days for patients to Google their way through their diseases and treatments. They learn how to interpret their blood tests and which further ones make sense. They know the value of a second opinion and don’t feel awkward about getting one. Many can actually speak fluent medicalese.

The best cure I know for helplessness is finding some control. Control, in addition, affects survival duration and life quality. If I’ve seen any correlation between patients’ choices and their outcomes, it is this: people seem to do best when they’ve consciously selected their treatment. (By the way, this includes those who consciously select alternative treatment and even no treatment.) 

To be assertive doesn’t mean contravening physicians’ medical judgment, only researching and then expressing preferences. I call it “smart shopping.”

Hanging out with assertive cancer patients has benefited my own healthcare. I have something called “Dupuytren’s contractures,” in which tendons in the palm tighten, slowly bending the hand into a claw. When I showed this to my physical therapist—a truly gifted healer—she said, “Oh oh. You’re going to need surgery.” 

Some years ago I probably would have passively acceded, and headed to a surgeon. Instead, I said, “Only if we can’t fix this ourselves.”

She was game. Ten visits plus procedures at home, and voila! No claw hand.

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