When I read the following Facebook post from my friend Aviva Romm, MD, it struck me that if a Yale-trained physician who works with Mark Hyman, MD has this much trouble getting the kind of medical care we all deserve, we have a bigger problem than I even realized. Fair or not, usually doctors get easier access to health care than those outside of our field. As a professional courtesy, we tend to wait less, get squeezed in emergently, have easier access to communication with our physicians, and even pay less money sometimes. (We don’t necessarily get better health care because doctors tend to overfuss over other doctors, but that’s a whole other story. Don’t even get me started on my own childbirth experience!)
But I digress. Reading Aviva’s story inspired me to share it with you, not only because I hope it lights a fire under you to join the revolution to heal health care, but because I want you to realize that if you’ve ever felt disempowered in the doctor’s office, you’re not alone. Even doctors feel this way sometimes.
Take it away, Aviva!
This week I had to be a patient. I was having some strange abdominal symptoms and finally decided it was time to have a check up. It took me 2 weeks to get in with a doctor and I finally had to have a friend get me in because the more open minded docs in the area aren't taking new patients. I then had an appointment with a nurse practitioner who barely ever looked at me (I finally made her laugh and she eventually connected.) Instead, her eyes were fixed on the electronic medical record the whole time. I was seated in a very low chair, and she was on a stool that was at its highest position, so I felt like a child physically - not really a power position! The exam was incomplete (my abdomen was never palpated!) and done improperly and all that was done was to turf me to the next level of care - an ultrasound. I had to ask for the lab tests that were appropriate to create a meaningful differential diagnosis (thyroid, anemia, etc).It was unclear when I'd be able to get in for the ultrasound, but I was able to pull the "I'm a doctor" card, and they got me in within hours. After a very painful transvaginal ultrasound and a not painful abdominal ultrasound with the tech, who was very nice and seemed thorough, making some slightly concerned faces and looking at some areas for longer than usual (I'm a doc, so I know how long things should generally take to examine), I was told it might be 48 hours before I heard results. 48 hours? The radiology suite at the local community hospital was empty and there's a radiologist in there!
As I wrote about here, too many patients hand the power of their health over to physicians who they believe will fix them, and then if the doctor fails to cure what ails them, they get frustrated and feel like helpless victims of bad luck or bad genes.
But studies show that being proactive about your health not only results in better health care; it also strengthens your body’s natural self-repair mechanisms and helps your body fend off illness.
Your body is your business! Even though most of us doctors went to school for over a decade, ostensibly so we’d know your body better than you do, nobody knows what’s best for your body, mind, and soul as much as you do. Your body is your business because you are the gatekeeper of your mind, and it’s your responsibility to protect your body from the poisonous effect toxic thoughts, beliefs, and feelings have on your body’s physiology.
There are many ways you can be an empowered patient, but here are a few tips for taking the power of your health back into your own hands.
1. Guard your mind and reject negative health beliefs.
Just because your doctor tells you there’s only a 10% chance you’ll get better doesn’t mean you have to think like a pessimist and look at the glass as 9/10 empty. Reframe the numbers and focus on the fact that 10% of people with your disease get well - and for the 10% who do, the other 90% don’t matter. Remember that those positive health outcomes aren’t just flukes. Those who get well against all odds share common proactive characteristics. (To learn 6 scientifically proven proactive things people with stage 4 cancer who experience spontaneous remission share, read Mind Over Medicine.)
2. Avoid toxic situations when possible.
If you feel like a victim- of an abusive childhood, a toxic marriage, a soul-sucking job, a demeaning boss, a bankruptcy, or whatever- find a way to reclaim your power. Dig deep within and call upon the strength you’ll need to make healthy changes in your life, even if it means financial loss, loss of status, disappointing others, or other undesired consequences that may accompany extricating yourself from mind-poisoning circumstances. If you can’t change your circumstance, you still have the power to change your attitude.
3. Don’t be afraid to question your doctor.
Remember, medicine is a service industry. If you didn’t feel like your car was in the very best hands possible, you’d find another auto mechanic. Proactive patients- the ones who have the best health outcomes- don’t hesitate to ask their doctors questions, get second opinions, and switch health care providers if the fit isn’t right.
For example, when your doctor makes a diagnosis, ask your doctor, “What else could it be?” Every doctor should have what’s called a “differential diagnosis,” and sometimes asking your doctor to expand the scope of what your diagnosis could be can leapfrog you to optimal health sooner.
When my literary agent Michele read the first draft of my book Mind Over Medicine: Scientific Proof That You Can Heal Yourself, she said, “Lissa, before I read your book, I honestly thought my body was none of my business. It was my doctor’s business. I thought my body was like my car. When my car breaks, I hand it over to my auto mechanic and expect my mechanic to fix it and hand it back to me. I expected the same from my doctor. But after reading Mind Over Medicine, I now know that my body is my business, that nobody knows my body better than me and that my health is my responsibility.”
In my decades of experience working with patients as a physician, Michele’s formerly passive approach to her health is not uncommon. Many patients take this auto mechanic approach to health, handing over their bodies to doctors they may not even screen as carefully as they choose their auto mechanics, never questioning what the doctor says, seeking clarity when they’re confused, asking for second opinions when they doubt the diagnosis or treatment plan of the doctor, or taking their bodies elsewhere when something doesn’t feel right.
Essentially these patients, especially the ones who have been labeled with a “chronic,” “incurable,” or “terminal” illness, have been programmed to believe that Western medicine has done all it can do and they are therefore at the mercy of doctors who can’t cure them. They often come to experience what physician and researcher Martin Seligman coins “learned helplessness.”
From time to time, pain grips Anna’s belly so severely that she has to excuse herself, hide in the bathroom, double over on the toilet, and dab herself with lavender oil to try to keep from puking. The first time it happened, she called her best friend, who took her to the emergency room, where they poked, prodded, scanned, and examined Anna, only to dose her up with morphine, shrug their shoulders, and send her home with Vicodin and a referral to a gastroenterologist.
But then it happened a few days later. So Anna made an appointment with the gastroenterologist, who sticks a scope up Anna’s butt and slaps her with the label of irritable bowel syndrome. Anna tries a few medications, as well as some dietary changes, but the pain actually gets worse. When she tells this to her gastroenterologist, the doctor refers her to a gynecologist, who performs laparascopic surgery on her and diagnoses her with endometriosis. The gynecologist recommends a drug called Lupron, which puts 32 year old Anna into temporary menopause, but when Anna tries the Lupron, her hot flashes, insomnia, vaginal dryness, and night sweats are so severe, she decides the belly pain is less traumatic than the menopausal symptoms, so she stops the Lupron.
Procedures… And More Procedures
Because the first dose of Lupron hadn’t helped her symptoms, her gynecologist suggests she visit a urologist, so Anna complies. The urologist performs yet another procedure, putting a camera into Anna’s bladder. The urologist detects some worrisome abnormalities and diagnoses her with interstitial cystitis. More drugs are prescribed, as more dietary adjustments are made.
The next week, Anna is doubled over on the toilet, again, soaking herself in lavender oil at least twice a day.
Yet nobody ever talks to her about the fact that her pain only appears when her Devil Wears Prada boss storms down the hall with one of those, “How dare you fail me like this - again?” grimaces on her face.
Most of us have heard of “the placebo effect,” the heal-inducing effect patients in clinical trials experience when they believe they’re getting a fancy new drug or surgery but are actually getting fake treatment. The placebo effect is real, it works about 18-80% of the time, and it’s not just in your head - it actually dilates bronchi, heals ulcers, makes warts disappear, drops your blood pressure, and even makes bald men who think they’re getting Rogaine grow hair!
Unwanted Side Effects
But the placebo effect has a shadow side. The same mind-body power that can heal you can also harm you. When patients in double-blinded clinical trials are warned about the side effects they may experience if they’re given the real drug, approximately 25% experience sometimes severe side effects, even when they’re only taking sugar pills.
Those treated with nothing more than placebos often report fatigue, vomiting, muscle weakness, colds, ringing in the ears, taste disturbances, memory disturbances, and other symptoms that shouldn’t result from a sugar pill.
Interestingly, these nocebo complaints aren't random; they tend to arise in response to the side effect warnings on the actual drug or treatment. The mere suggestion that a patient may experience negative symptoms in response to a medication (or a sugar pill) may be a self-fulfilling prophecy. For example, if you tell a patient treated with a placebo he might experience nausea, he’s likely to feel nauseous. If you suggest that he might get a headache, he may. Patients given nothing but saline who thought it was chemotherapy actually threw up and lost their hair!