By Vicki Rackner, M.D.

From the T-shirts of Babes

At the airport the other day, as I walked toward baggage claim, the words on a red t-shirt worn by child, maybe about four years old, caught my attention: “For conversation’s sake, let’s assume I’m right.”

I thought, “This should be printed on each and every patient gown!”

As a patient, you desperately want your doctors to be right.  You expect he’ll give you the right diagnosis.  Or she’ll give you the right medicine. Or they’ll offer the right words of encouragement.

When it comes to your health, the phrase, “I’m right,” really means, “This is the way I make sense of what’s happening in my body. This is my health belief.”

You have your own ideas about what causes your joints to hurt, or why you got cancer, or whether prayer supports healing. When I ask my patients what they think is wrong, they usually have a diagnosis.  Sometimes, their diagnosis is correct. Other times, I disagree with their assessment. When my opinion differs from my patients, I make sure to tell them that I respect their opinion, but they might want to consider other ideas. Then I will give them my diagnosis. Unfortunately, not every doctor takes so kindly to differing opinions.

Conflicts between doctors and patients often arise because doctors and patients hold different health beliefs. Some brave patients openly challenge their doctor’s beliefs.  They make bold statements such as, “It wasn’t the medicine you prescribed me, it was the vitamins that cured my cold,” or, “My arthritis isn’t getting worse, it’s just this rainy weather that causes it to act up.”  Sometimes, a doctor will dismiss these statements outright. The patient will often feel angry that, thinking that the doctor doesn’t care about what they believe.

When a patient doesn’t feel that a doctor respects their beliefs and opinions, they can become reluctant to voice their thoughts. Therefore, many patients who see the world differently from their doctors simply remain silent.  They quietly listen to their doctor’s suggestions, then ignore them and treat what ails them with a self-care remedy that makes sense to them. Sometimes the self-care remedy works, but sometimes it could be dangerous or conflict with prescription medication. The best solution is to find a doctor that you feel comfortable speaking to openly. Have a conversation about your beliefs and try to work with your doctor to best serve those beliefs.

Let Your Doctor Know Your Beliefs

It’s unlikely you’ll get a mammogram if you think x-rays cause cancer.  You won’t fill your prescription if you simply don’t take pills…ever. And you won’t stop smoking if you think that the doctor can fix your heart or lungs if bad things happen.

Up to now health care has focused around the doctor’s beliefs and patients were discouraged from offering their own thoughts. Here are some reasons to tell your doctor yours.

• You might have the key to the diagnosis. Susan innocently asked, “I wonder if my breast pain means I need to get a new bra.” Voila! Her breast pain went away after she got a well-fitting bra.
• Your health beliefs shape your health choices. Let’s say you think vaccines prevent the flu, and hand washing is not important.  You might deny yourself access to the most powerful anti-flu intervention we have!  You can ask your doctor, “How effective is regular hand-washing in preventing colds and flu?” (Hint: please wash your hands regularly, it really makes a difference!)
• Your health beliefs shape your health outcomes.  The most dramatic example is the placebo effect.  Study after study shows that many patients who receive a “sugar pill” get the same measurable results as those who take an active ingredient.  In other words, the belief in the therapeutic power of a certain intervention makes it so! When your doctor takes out the prescription pad and says while writing, “This medicine will make you better in no time,” it usually does. Maybe the doctor’s words augmented the power of the chemical ingredients? Conversely, if you have no faith in a particular treatment or medication, the outcome of that treatment could be adversely affected.
• Your health beliefs might be based on incomplete information.  When you say to your doctor, “I don’t have time to get a second medical opinion because the cancer cells are spreading each moment I wait,” your doctor is able to say, “Our best evidence shows that one or two weeks will not make any difference in your outcome.”  Doctors get more evidence all the time and change their health beliefs based on that information.  In George Washington’s day, bleeding and purging were the treatment of choice for most medical conditions.  As new information became available, doctors changed their health beliefs.

Next time you go to your doctor, take an active role in your health care.  For conversation’s sake, let’s assume you’re right when you say, “I never went to medical school.  Still, I wonder…”

The best health care team is one where you, your doctor, and other health professionals work together.