By James E. McMinn, M.D.
ER Doctor: What medications are you on Mrs. Jones?
Patient: I’m taking a blue pill, a red pill, and a yellow pill.
ER Doctor: What is the name of these pills?
Patient: I don’t know.
ER Doctor: What are you taking them for?
Patient: I don’t know, my doctor just told me to, so I take them.
I heard some variation of this theme played and replayed hundreds of times in my many years as an ER doctor. It characterizes a paradigm of the dogmatic, paternalistic doctor on the one hand, and the unquestioning naive patient on the other. This is a doctor-patient relationship that I feel and hope is archaic and rapidly changing.
Old school: the doctor is completely responsible for the patient’s health. The patient blindly trusts the doctor, follows orders, and never gives it a second thought.
New school: The doctor and patient work together as partners, but ultimately the patient is the captain of the ship.
Clearly, if the patient is in the ICU, unconscious and on a ventilator, then the doctor makes the calls. However, for the other 99% of the patient’s life she should be given the opportunity to fully understand her individual health status, and participate in decisions regarding her health. The relationship between the doctor and the patient should be a dynamic two-way exchange of information that allows the patient to make informed decisions about her health.
In my practice I frequently take my patients through a visualization exercise. I invite you, the reader, to do this with me now.
Imagine that we are out on the high seas in a magnificent sailing vessel. The name of the vessel is the “Titanic.” You are the captain of the ship, and I (your physician) am your humble navigator:
Navigator to Captain: “Ahoy, Captain, iceberg straight ahead. I can see it in plain sight captain. If you turn to the right you’ll miss it completely and sail out into clear waters.”
Captain (you) to navigator: “Don’t bother me now navigator. Can’t you see, I’m busy?”
Navigator to Captain: It’s getting closer Sir. I can see a name on the side of the iceberg. It says, “HEART ATTACK, STROKE, DIABETES.”
Captain to Navigator: “OK, OK, I’ll get around to it tomorrow.”
Navigator to Captain: “You must change courses NOW Captain, or you’ll sink the ship.”
The end of the story has not yet been written. Each of us will finish our own script according to our day-to-day choices, actions, and inactions. As a physician, I can tell a patient over and over, until I am blue in the face, to lose weight, to exercise, to get more sleep, to stop abusing alcohol and drugs. Furthermore, if I am an excellent physician, I will teach them, give them tools to be successful, and hold them accountable. However, ultimately it is up to them to heed the call and steer their ship to clear waters.
We are each given a magnificent vessel. I never cease to be amazed at the beauty, complexity, and splendor of the amazing human body. It is up to each of us as to what we do with it. Do we respect it, love it, nurture it, and make it prosper, or do we abuse it with stress, toxins, obesity, drugs, alcohol, no sleep, and junk food?
It reminds me of the parable about the ten talents. One person buries his talents beneath a rock and stagnates, while the other grows and nurtures his talents and prospers. Which path do you choose?
Gone are the days when a patient should just take the blue pill and the red pill just because their doctor told her to. Patients need to ask the questions and health care providers must we willing to provide the answers, so that the patients can be empowered to optimize their wellness. For it is the empowered patient and the educated patient who becomes an inspired, and compliant patient.
Physicians and health care providers need to realize, as Bob Dylan once said, that “The times they are a Changin,” Just yesterday one of my patients, who happens to be the nicest, sweetest, most humble lady, said that her doctor actually got irate with her because she didn’t “just take the pill.” She wanted to know why she had to take this pill. She wanted to know her options. It’s her body. She has a right to know what she’s putting into it. Unfortunately, he didn’t see it that way.
In summary, the pendulum is swinging toward a more empowered, educated patient. To patients I say: take ownership for your body. Take care of the amazing, miraculous vessel that you were given. Ask the questions. Read the books. Be proactive. Shake off the shackles of the victim role. Grow, learn, and cherish this mind/ body/ spirit that you were given. Understand that you are the one who ultimately must be accountable for your actions or inactions.
To physicians and health care providers, I ask that you embrace this change. It’s hard to teach us old dogs new tricks, but at the end of the day, patients and providers will benefit. Partner with your patients in their treatment of disease and their quest for optimal wellness. Love them. Care for them. Teach them. Empower them. Show them the way, and motivate them to go there. Hold their hands when you need to. Steer them away from the looming icebergs of diabetes, obesity, heart disease, cancer, fatigue, and countless other maladies, and guide them to clear sailing. At the end of the day, understand that it is the patient who is the Captain, and you are the humble navigator. The days of the dogmatic and paternalistic medical paradigm are over. In the end we will all be better off for the change.