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September 16, 2006

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I will be blogging on this, but I no longer go with my husband to his appointments.

Now, I treat patients the same whether family is there or not or whether family has a medical background or not.

I may use medical terminology to the family member, but always make sure I use lay terminology for the patient.

No, you shouldn't have to play "games" (my term) when you go see a doctor.

Write down your questions, even hand them to the receptionist ahead of time, but I think that unless you are unsure, or are receiving difficult information (biopsy results, chemo decisions), you should be able to handle a doctor's visit alone.

If you aren't comfortable doing that, you need a new doctor!

I think Dr. Hildreth was being a wee bit tongue in cheek.

That said, there is probably a grain of truth in it all. Bias can be subtle and unintentional, but it's there. The bit about the solitary patient especially resonated with me. I feel physicians can be subtly dismissive of patients who are unaccompanied, and I can't help wondering if it makes a difference when the physician knows he/she has family members to be accountable to.

I don't watch "ER" anymore, but a few years ago there was an episode during which Carol Hathaway accidentally transfused the wrong blood type into a patient and the patient died. The hospital's risk manager was afraid of a lawsuit, but when the staff told him the patient was an uninsured, homeless alcoholic, his response was, "thank goodness."

Nominally we all should be equal, but I think it's pretty clear that some patients are more equal than others.

This may annoy doctors, but I have given up shaving and dressing up nicely before going to doctors and specialists for the first time (I am 25 and have Myasthenia Gravis, btw, which is currently uncontrolled, so I spend lots of time seeing doctors of all stripes) because the more functional I look the less serious I am taken. Just because I do not look like the typical 60 year old with a neuromuscular disorder, doesn't mean that everythings fine.

No, you're not overthinking this issue. There is no way to overthink this issue. I am my mother's medical advocate. She has what I refer to as Dementia-Lite, thus, she needs someone in the office with her, even though the doctor is aware enough not to speak around her, but to her, and to ask his questions directly to her. I'm aware enough to wait to see if she'll answer, and if she'll answer "correctly".
However, I can tell you, I prepare ahead for my mother's doctor's appointments, start preparing him two weeks in advance, keep him supplemented with monthly Blood Glucose, Blood Pressure and health reviews and, I am courteous, respectful and dogged and, still, it isn't uncommon for the doctor to remain unprepared for the appointment and for me to leave with lagging frustration. Have we tried other doctors? You bet. This one, so far, is the best of the lot, and, frankly, I am soooo tired of trying new ones. Despite my mother's voluminous health history, no one seems to want to read it, they all want to start over...they don't trust my knowledge of her medical history...it goes on and on.
It's not you, it's The Times of Medicine, and The Times When Patients MUST think deeply and often about doctor's visits.

My husband and I are both attorneys, and we make it a point to *avoid* telling our doctors this fact. We think it makes them nervous. We could always pull out the "lawyer" card later, if necessary, but under any circumstances I could immagine we would be looking for another doctor at that point, anyway.

I am a physician and I disagree with the advice above. I feel (and I think many of my colleagues agree) that a patient who shows up with a written list is probably a nut-case. I prefer that people come alone because the dynamic with the third person is often weird - either they sit and read a magazine (rude to the patient) or they are confrontational. Many women who have controlling men in their lives show up for routine visits with these men and it seems they can't do anything for themselves. Telling the doc you have doctors in the family or lawyers will backfire because it's obvious that you're trying to intimidate. Believe me we are afraid of being sued by every single patient we see so mentioning a doctor or lawyer in the family won't help. In one case a patient's son claimed to be a malpractice lawyer. He was such a jerk I got curious and googled him - and gleefully discovered that he was a lawyer but not a malpractice lawyer and that he was involved in a very public and embarassing lawsuit! I am always relieved when the interaction with the patient is not adversarial - the non-adversarial patients are the ones I spend more time with, am more quick to call back etc. Doctors are people too, and we don't want to deal with difficult people any more than anyone else does.

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