September 09, 2012
BehindTheMedspeak: Why it's best not to take your doctor's word for anything
About 11 years ago I had a bout of iron deficiency anemia which compelled me to actually go to a doctor — something I avoid whenever possible.
I diagnosed it myself from changes in the curvature of my fingernails*, something I remembered from med school ages ago.
It was clear I needed a workup and treatment that was beyond the scope of my anesthesiology training + do-it-yourself ethos.
Long story short: The internist made the diagnosis and prescribed treatment with an iron supplement along with monthly monitoring of my red blood cell level.
After two months there hadn't been any improvement.
I went online and drilled down really deep and discovered that the internist's instructions on how and when to take my iron supplement were completely wrong.
He'd told me to take my iron with meals.
In fact, iron supplements should be taken on an empty stomach — and absorption is markedly enhanced by vitamin C.
I bought a bottle of vitamin C tablets and started taking one with each iron tablet — between meals.
In a month my red cell count was up and it kept increasing, reaching a normal level after four months.
The thing is, it's hard for someone who's not a doctor to drill down and interpret the original papers on a subject like the treatment of iron deficiency anemia — much less cancer or infectious diseases and their ilk.
There's a ton of contradictory information and even my board-certified, otherwise excellent internist — selected by me only after a really thorough vetting and exploration of doctors in the Charlottesville area — was ignorant of something that should have been basic knowledge for him.
Did I ever tell him I'd discovered he'd misinformed me?
That's not my job.
My job is to be a patient and get better.
Besides which, I may need to see him again one day and that'll go a whole lot better without my having called him out.
Note added at 9:33 a.m. Monday, September 10, 2012:
*From Wikipedia: "'Koilonychia' (from the Greek: koilos-, hollow, onikh-, nail) (also known as spoon nails) is a nail disease that can be a sign of hypochromic anemia, especially iron-deficiency anemia. Koilonychia [below]
literally means 'spoon nails.' It refers to abnormally thin nails (usually of the hand) which have lost their convexity, becoming flat or even concave in shape."
September 9, 2012 at 04:01 PM | Permalink
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skepticism advised then
Posted by: sherlock | Sep 12, 2012 3:09:41 AM
The drumbeat of a physician's training - you must make the right decisions and you must make them with confidence - combined with the Insurance industry warning to never, never, never admit making an error lest you draw a lawsuit makes Joe's point quite clear.
I've crafted multi-page, information-dense, entirely objective analyses of medical error regarding an elderly family member who would not take his meds as ordered (for atrial fib) where he had thousands of Coumadin tabs in his apartment together with wildly varying lab results from his monthly Coumadin tests because he gamed the system by taking a few pills the day before his blood tests. Photos of the vast number of Coumadin bottles (unopened, dated sequentially), together with a graph of the wildly varying lab results for the previous three years met with total denial by the attending.
Posted by: 6.02*10^23 | Sep 11, 2012 9:35:28 AM
Re: "curious that someone in the medical profession has such a low opinion of colleagues/egotists"
It began the first day of medical school, when I looked around and saw who else had survived the brutal, Vietnam War-draft era application process.
I was out of place.
And that's a major understatement.
Over four decades of close association with their ilk have proved my initial take spot-on.
Posted by: bookofjoe | Sep 11, 2012 9:35:16 AM
curious that someone in the medical profession has such a low opinion of colleagues/egotists
Posted by: sherlock | Sep 11, 2012 4:41:46 AM
OK, understood, you better than most would understand the M.D. psyche. I stand corrected.
Posted by: tamra | Sep 11, 2012 4:29:16 AM
YOU ARE THE BEST!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
Posted by: larry ziegler | Sep 10, 2012 2:57:16 PM
Alas, not only is a doctor who's told he's wrong by a patient far more likely than not to shoot the patient/messenger (as it were) but he's also going to reflexively dismiss the conflicting message. So not only will future patients not gain from the effort, but the offending individual will find his physician views him in the future with a gimlet eye. Bottom line: no gain, lots of pain. Do the math.
Posted by: bookofjoe | Sep 10, 2012 9:40:36 AM
IRTA as "irony deficiency" and thought that was standard for Americans. ;)
Posted by: Graeme | Sep 10, 2012 12:17:54 AM
Bristle or not Joe, I agree with abj, his ego be damned, even if he gave you the evil eye, he might give the next several hundred patients the advice that would make that difference that your research made for you. That's more important than offending him for a moment. Better to be a dead messenger than to remain silent.
Posted by: tamra | Sep 9, 2012 10:01:37 PM
abj: Most doctors I have known over nearly four decades in the field are NOT receptive to correction from patients but, in fact, bristle at same. Hence my silence.
Posted by: bookofjoe | Sep 9, 2012 7:09:01 PM
except that another patient that goes to your doc, who may not read your blog, could benefit from your withheld insights. if your doc is receptive to insights, which one would hope a carefully vetted doc would be....
Posted by: abj | Sep 9, 2012 6:59:47 PM
Sorry, meant to add - not strictly on-topic since it didn't involve a word to not take; it involved a word never given. But if it can help to relieve the discomfort of any cystitis-sufferer (assuming they're taking the necessary meds to actually get rid of it), then great.
Posted by: Flautist | Sep 9, 2012 6:10:56 PM
Many years ago I developed a horribly painful case of cystits, complete with bladder spasms and that wretched feeling of needing to pee every two minutes but all it does is hurt. I saw the doctor, got the Rx for Bactrim or Septra or whatever it was, and he never once mentioned (and I didn't know back then) that in the meantime I could be getting enormous relief from the extreme discomfort by taking phenazopyridine (generic name), which is available over the counter as Azo-Standard, Baridium, etc., in any drugstore, cheap. Something so simple, and so effective, and I was never told about it.
Posted by: Flautist | Sep 9, 2012 5:59:15 PM
About 30 years ago my wife (RN, BSN, MBA) went to a dermatologist for help with acne vulgaris. After six months of treatment and no improvement she happened to learn that the tetracycline she was taking daily was being neutralized by the glass of milk she drank with it to prevent stomach upset.
She was pretty damn' mad that the doctor hadn't mentioned that possibility to her.
Posted by: PT | Sep 9, 2012 4:48:40 PM
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