I read two interesting sentences today about the act of doctoring.
The first from the White Coat Underground blog:
“Medicine involves a lot of salesmanship.”
The second was from this NY Times health piece highlighting the difficult decisions that arise when recommending procedures to an elderly patient:
“…[Have] you felt that a doctor or hospital was steering an elderly parent toward a test or procedure that just didn’t seem necessary or advisable?”
The notion of selling something to patients gives me heartburn. I don’t look at it that way. But maybe I should?
I don’t consider the office encounter a chance to convince a patient to have a pacemaker, or an ablation, or to take a medicine. (Exception: I do try to sell the benefits of exercise, eating well and getting good sleep.) Rather, I try to lay out the pros and cons of having a treatment, or having the problem.
I want my patients to know that I believe strongly that they should decide what is best for them. For it is their body, their life, their choice. I want to share, as skillfully as possible, my knowledge, judgement, and experience with them. But I don’t want them to think that I am selling something.
Recently, after a detailed, white-board-aided discussion of AF treatment options (A: live with it; B: take a medicine: C: have an ablation), the patient said this:
“Doc…Let me ask you just one question: Since you are the expert, What do you recommend?”
This patient wanted me to decide. I used to like this. It was easy. I was in my thirties.
But as I age-up in doctoring years, making decisions for people becomes more difficult.
I wonder what this means, other than…wondering too much makes for running behind schedule?