Thursday, March 21, 2013

Another Rant

It’s my blog, and I’ll rant if I want to.

Here’s how I want to be treated when I go for a medical appointment.  I’ll state up front, that it takes more time to do medicine my way, but I think it’s worth it.

If a doctor wants to do a test, I want to know the reasons.  How likely is it that the test will find anything, given my general health? Will it hurt? Are there risks?  The choice is mine – not the doctor’s.  When I went for a stress test, the young doc who ran it wanted to run a camera inside my heart.  I’m in better shape than he is.  I’m more than twice his age, and I’m sure I could beat him in a bike or swimming race.  Some random anomaly is no reason to run invasive tests.

If a doctor wants to prescribe a pill, I want to know about the side effects. I want to know about the success rate. It’s my choice if the possible benefits outweigh the risks.  My cancer surgeon wanted me to take aromatase inhibitors for 5 years.  She said they reduce the chance of getting cancer in my other breast by 50%.  She didn’t tell me that the chance of getting cancer in my other breast during a 5 year period is 3% and the pill cuts it to 1.5%.  I do not consider that to be a significant advantage.  She said the pill is well tolerated.  According to what I read on the web, side effects are common and so horrific that many women quit the pill long before the 5 years.  The side effects include hot spells worse than menopause, short term memory loss, painful joints, brittle bones, and migraine headaches.  In my opinion, for my health care, the benefits alone aren’t worth taking a pill, even if there were no side effects.  The bottom line is that getting cancer in one breast does not make me more likely to get cancer in the other one than someone who has never had cancer.  And taking the pill has no effect on my anticipated longevity. This is the type of information I want my doctor to tell me.

If a doctor wants to recommend surgery, I want to know the details.  My breast surgeon wanted to do reconstruction.  She recommended inserting a bag of salt water.  She said it was just one more surgery after the mastectomy.  That’s simply not true.  The bag must be replaced every 10 years.  So, given my longevity expectations, that means 4 more surgeries.  I looked for consumer satisfaction reports on the web.  Nobody who has posted seems happy with the feel of a bag of salt water under her skin.  I don’t like the idea of something artificial under my skin.  I agreed to the hip replacement because I couldn’t ride my bike with the worn-out one.  I can’t think of a single thing I could do with a bag of salt water.  Plus, reports say that the plastic insert that stretches the chest muscles to make room for it hurts. And this kind of reconstruction interferes with doing yoga.  I love doing yoga.  That seals it.  No insert for me.  My doctor didn’t mention any of this.

If a doctor wants to recommend stretches or exercises, I want these stretches or exercises demonstrated.  I want lessons in how to do them.  If appropriate, I want a physical therapist to work with me.  “You need to stretch,” doesn’t mean anything to me.  I probably stretch more than anybody else I know.  But if there is a specific stretch that would help, I’ll add it to my regimen. I just need the details.

Finally, I don’t see any reason to see specialists if I don’t need special services.  I see no reason to visit a surgeon to get my remaining breast checked every year.  As I said, I’m no more likely to get cancer in that breast than a woman who still has two breasts.  And if a general practitioner can detect cancer in a woman with two breasts s/he could detect it in my one.  Specialists are harder to schedule. They cost more. And they don’t have time to talk to me.

If doctors don’t have time to talk to me, then set up a system of nurse practitioners who do.  I’m not a car. I have pain sensors and decision making abilities. I want to be treated as a whole person.

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