Doctor D Crossed The Line!

Doctor D has been blogging about the Doctor-Patient relationship for a while now. It’s sort of the thing I’m known for. I’ve usually been on the doctor side of this equation. Most of my blogging, however, is to help patients figure out the weird world of medicine.

Well, guess what? Doctor D recently found himself on the patient side of a nasty injury!

Even as Doctor D looked down and realized his leg wasn’t supposed to be that shape he said to himself, “Self, take mental notes! The readers of Doctor D’s Clinic of Doctor-Patient Relational Awesomeness will want to know about this."

Here is what Doctor D discovered when he became Patient D:

1) Doctor D Is Mostly Right

Any reader of this knows that Dr. D’s insight is typically brilliant and totally useful. I found myself actually looking up posts I had written for the solid and useful advice.

But even D has a lot to learn, so from here on I shall delve into the dark secrets I could only discover when crossing the line to the patient side!

2) Being The Patient Is The Hardest Job In Medicine

We doctors think we have difficult work. We have to slave our asses off for years in school. We are expected to be perfect and heroic while working with huge uncertainty. We try to protect your health, comfort, and life, while you patients just lay back and get taken care of!

Lying here isn't as relaxing as overworked docs think it is.

Just a few days as a hospital patient cleared my mind of any misconceptions. Abject helplessness combined with severe pain trumps everything. And helplessness is far worse than pain. Dr. D had never done anything as a doctor that caused more stress than allowing myself to be put to sleep for a major operation with a surgeon I had only spoken to for 30 seconds.

3) There Is Much More To Pain Than A Number

Doctor D has written a lot on pain scoring, so I attempted to rate my own pain as a matter of curiosity. I have a good imagination for what 10 out of 10 pain would feel like, so I gave the feeling of multiple shattered bones crunching whenever my leg moved a 7, which made it the most intense pain I’ve ever felt, but I could totally handle the excruciating acute pain.

The real surprise was realizing that duration of pain was far worse than intensity. I had a throbbing pain during my recovery that I could rate as a 4 if I’m generous, but it lasted for weeks and nearly drove me insane. Low-intensity pain that won't leave can make a person much more miserable than 10 out of 10.

4) Narcotics suck

I’ve seen a lot of nice people get addicted to opiate pain medicines. So Doctor D was the dude in the ER with a bone sticking out of his leg begging not to be given morphine. When they finally convinced me to take the narcotics I was please to discover I didn’t get any high. But what I did discover is that they made me miserable in other ways. I was groggy, nauseated, itchy, constipated, and mushy-brained whenever I had to use them.

Their efficacy varies drastically from person to person. I can say with certainty that a 400 mg Ibuprofen was significantly better for pain for me than a 10 mg Percocet, but since my Ortho wouldn’t let me use ibuprofen I was stuck with narcotics. So I then had to deal with the suspicious look when I told the doc I needed more because I had run out.

I am so happy to be off those things! As a physician, it was a bit eye opening to experience how inconsistent and imperfect our best pain medicines are. Managing the pain of a fellow human being is about as frustrating a situation as an MD can experience. I doubt my prescribing patterns will change much, but I do have a deeper appreciation for how hard it is to correctly wield the double-edged sword of pain medicines.

5) Being Disabled Can Really Crush An Ego

Regular visitors to The Clinic of Doctor-Patient Relational Awesomeness are likely aware that Doctor D has a very healthy self-esteem. 3 weeks of lying on my back absolutely helpless and unable to do anything had me at the lowest place I’ve every been. One night I—a generally tough dude—cried myself to sleep. I’m up and moving better now, but I will likely have a limp the rest of my life. My whole life I’ve been able to do everything physical I wanted to do. Now I’m one of the broken people. It’s going to take some getting used to.

I know as physician I often see people with broken and damaged bodies. It kind of annoyed me when people whined about it. “Look, we can’t fix everything, so be a grown up, get over yourself, and quit complaining!” It’s easy to feel this way when you aren’t the one with the disability. I’ve given myself that same pep talk a lot in the last two months—It doesn't work as well when I’m the one with the gimp leg. A lot of my patients have far worse problems than my leg ever was. I’m manning up to fact that my leg’s gonna hurt for decades, but I think I’ll be much more patient towards patients with severe disabilities in the future.

You can't say you wouldn't complain about it if you've never been there—it's a good thing for docs to keep in mind.

6) There Isn’t A "Sort Of Person" These Things Happen To.

Okay, I have to admit something a bit embarrassing here: We doctors sometimes think of our patients as a completely alien form of human life. It isn’t intentional. We wouldn’t even admit it out loud. It’s a weird psychological quirk that happens like a reflex.

Doctor’s see so much suffering and misery on a daily basis, and we just can’t spend all our time worrying if it will happen to us too. So we develop this mental trick: "These things won’t happen to me, because I’m not that sort of person." What sort of person? Well, the sort of person who ends up the patient with a painful or horrible condition, of course!

Unfortunately, psychological defense mechanisms are useless when the cold, harsh laws of physics apply pressure to human bones. This shit happens to everybody—even doctors. No one is the sort of person that has a debilitating injury, until it happens.

7) Some Doctors Just Can’t Be Helped

Doctor D has spent a lot of time educating you on how to deal with difficult doctors. One of the worse maladies plaguing the medical field is piss-poor communication, and Dr. D’s orthopedist has about the communication skills of a mentally-retarded clam.

There's a lot that patients can do to improve their communication with difficult doctors. I had a lot of questions, and I found myself going and reading my own posts for advice on how to get answers out of a doc with weak bedside manner.

In the end I just gave up. This dude just couldn’t communicate like a normal human being with a patient (even a patient who had an MD). I hear he’s an excellent surgeon and the fact that my leg got put back together is proof of this, but his ability to converse was just dismal.

"I'm sorry, but I don't consider speaking with you to be part of my job description."

When faced with a doctor who simply will not or cannot communicate a patient has two options: Leave or trust blindly.

Dr. D had a FUBAR leg, there was only one Orthopedist available at 1:00 am, and the ER doc said this dude was a good surgeon. So I trusted him even though he seemed mentally incapable of explaining the operation he was going to do. The gamble paid off and the leg is improving, but generally I would have to advise that you hit the road when paired with doctors incapable of communicating—especially if your doctor will need to manage your problem longer than a 2 hour surgery.

Okay, that’s my story and I’m sticking to it!

Doctor D is back to limping around the exam room with patients, and so Doctor D’s Internet Clinic of Doctor-Patient Relational Awesomeness is back too. Send in those questions and I shall keep dropping knowledge on you!

What do you think?

Any of you medical folks have similar experiences and want to add some points?

Any of you with more experience as patients wish Dr. D had picked up more from his time on your side? If so, what did I miss?

Doctor D always loves to hear your thoughts in the comments!

Pills and Suspicions (Controlled Drugs)

A question Doctor D gets asked a lot:

Why are doctors so stingy with medicines that make me feel better?

Yeah, I have to admit doctors are totally difficult when it comes to certain pain and anxiety medicines. You show up in a doctor's office and request a medicine that has worked for you in the past and suddenly you get read the riot act and treated like a criminal. Weird isn't it?

Doctor D admits that he does this too. It's not because he doesn't care. D went into medicine because he cares. He has just learned to be cautious over the years.

These medicines are very powerful. Some people really do require them when other meds just won't work, but they can also get you high or even make you stop breathing. Every MD has seen these medicines destroy people's lives.

Heath Ledger and Michael Jackson kicked the bucket because of medicines like this, and Doctor D can guess what's probably gonna show up in Brittney Murphy's toxicology report.

But forget about celebrities, these medicines harm regular folks every day. There was the young mother that broke down in Doctor D's office saying she can't make it though a day without buying pills off the street, and the high school freshman that died of an overdose after spending her birthday money on pills to party with her friends. You don't forget patients like those.

It's one thing to see somebody hopelessly addicted to alcohol or die of a cocaine overdose. It is really sad.

But with prescription drugs it's different. I'm the supplier of drugs that are killing local kids and ruining families. You can see why I get nervous about every prescription for a controlled substance I write.

I totally want to help people in pain. Unfortunately that compassion makes me a sucker for manipulative people. I wish that I could believe what every patient says they need, but if I gave everything that was requested of me I would most certainly end up killing someone. Therefore Doctor D uses very conservative prescribing practices to make sure he has obvious medical reasons for every prescription he writes.

This sucks for patients with legitimate needs who use these medicines responsibly. The behavior of the bad apples causes good people with real needs to be treated like criminals.

Sorry! Doctors hate to act like cops, too, but the very serious drug problem puts us all in positions we don't like.

Please be patient with us. Doctors really want to help people, so if you are honest, patient, straightforward, and work with the system you will usually be taken care of. But doctors are edgy about these meds so please don't react with anger or game the system. I understand your frustration, but acting out won't help you. It will send up red flags that may get you banned from every getting strong medicines.

What do you think? Are doctors too hard on patients who need controlled drugs, or do you find the restrictions reasonable? Have you ever been mistreated when you asked for medicines? ...or known someone who was addicted to pills? Doctor D would love to hear your thoughts in the comments!