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How to survive your doctor

Advice from a seasoned M.D. on beating medical arrogance and a flawed system


 
(Andersen Ross/Getty Images)

(Andersen Ross/Getty Images)

During her second year of residency at Kings County Hospital in Brooklyn, Dr. Erika Schwartz was called to the ER to admit an elderly patient with a blood clot in her lung. She quickly realized the situation was dire and the woman was not going to make it; nothing she could have done would have saved the woman’s life. Realizing she would have to present this death in the morning to a department head known for his harsh treatment of residents, Schwartz wanted physical evidence of the cause of death. “I dragged the radiologist from his bed in the on-call room and begged him to perform an angiogram on the dying woman,” she writes in a new book, Don’t Let Your Doctor Kill You. “She drew her last breath on the cold, hard angiography table. I had my proof.” Schwartz then went to the waiting room to tell the woman’s husband that his wife of 50 years had died.

Schwartz, who went on to run a major trauma centre before opening her own private practice in New York City, has relived that moment throughout her 40-year career. “My actions were insensitive and inhumane,” she writes now. “The decent way to handle that situation would have been to sit down with the husband and tell him his wife was going to die; to tell him the truth about the reason why I wanted to have the angiogram; to allow husband and wife to be together for the few hours she had left.”

Schwartz’s book has numerous anecdotes about a lack of transparency in hospitals, the epidemic of over-testing and the dire state of doctor-patient relationships. She argues for the days of house calls, when doctors relied on their knowledge of their patients’ lifestyles and circumstances—not on a bevy of tests, technologies and drugs. She implores doctors to return to the profession’s sympathetic roots, and advises patients on how to find the right doctor, and be the right kind of patient—one who recognizes that she knows her body better than doctors do, and will not accept rude, impersonal care. “The word ‘kill’ in the title is not just about someone giving you the wrong medication or botching an operation,” says Schwartz, though, each year, more than 98,000 Americans and as many as 24,000 Canadians die from these kinds of medical mistakes. “It’s also how doctors will annihilate you as a person.”

Schwartz works in the U.S., but says the problems are universal. She places a lot of the blame on medical schools, with their culture of humiliation of residents before their peers. “Doctors emerge from medical school blindly following the authoritarian indoctrination they endured for four years,” writes Schwartz. “You’re trained to make life-and-death decisions in impersonal and emotionally disconnected ways.”

But that doesn’t mean a patient has to accept it, says Schwartz. Be prepared to walk away if the doctor doesn’t ask questions about your family, your job, your lifestyle, doesn’t make eye contact, isn’t listening and isn’t open to being questioned. “Unless you’ve been hit by a bus or are having a heart attack,” says Schwartz, “you have time.” Keep the focus on the ailment you came in for and ask how every recommended test will apply to your treatment. She’s seen too many patients enter the health care system for something minor and put themselves in the hands of doctors, who, in a blind pursuit of diagnosis, over-test and over-treat. Inevitably, the patient ends up sicker. “It’s like donating your body to science while you’re still alive.”

Throughout her career, Schwartz has honed her brand of patient-centred care. She bans pharmaceutical reps from her practice, doesn’t prescribe drugs that have yet to stand the test of time, and will make house calls. Appointments start in her office, with chatting in comfy chairs. (They move to an examination room if necessary.) It may sound corny, but Schwartz believes making her patients her friends, listening to them, supporting their decisions and, yes, even hugging them, has a dramatic and positive effect on their health. “We have learned to be service-oriented in every industry,” she says. “Yet, when you enter the health care system, where it’s life and death, you’re treated like a second-class citizen.” She thinks it’s time to fight back.


 

How to survive your doctor

  1. On the surface, fighting back sounds good. But it isn’t easily done when there is a shortage of doctors – and even fewer specialists with months-long waits.

    There is no doubt that something needs to be done though; there is insufficient sharing of information between various medical professionals. Results of tests are shared, but nothing on the conditions surrounding them, or more general observations that can help to put the data into some sort of context. This can be key in determining, for example, the correct treatment for someone with a serious, chronic illness being treated for something else – if the chronic condition is not properly considered, the wrong treatment – and even a wrong diagnosis – can result.

    My partner is gong through exactly this at the moment; she has to fight tooth & nail to get those treating her to PAY ATTENTION, and an injury that should have been long healed is still causing major problems months later as a result.

  2. This is patent nonsense! I am a senior who have had a few medical issues; including hospital stays. NEVER have I been belittled, ignored or talked down to. I have found, in general, hospital staff and doctors pleasant, helpful and mostly cheerful. Am I just a lucky one? I doubt it.

  3. This article, like most of Mcleans articles is written by an American. I have never had any of these issues in Canada. I thought Mcleans was supposed to be a Canadian magazine.

  4. Several years ago I was diagnosed with breast cancer – a reccurrence after 14 years – and was “assigned” a surgeon in Edmonton. I waited a couple of months to see him. He was a friendly man but he Did Not Listen to me. He asked questions without listening AT ALL to my responses, talked nonstop, and made a whole bunch of assumptions about what I needed. I left his office, found a surgeon who treated ME as an individual and an intelligent partner in my own health care, and received excellent care that took my needs and preferences into account.
    Not everyone who finds themselves in a health crisis can afford the time to seek out a physician who is a good match. Many of us are fortunate to find ourselves receiving excellent and timely care from wonderful doctors. But if you are uncomfortable with the first doctor to whom you are assigned, and IF you have time on your side – do your research. Get crystal clear on what is important to you. Line up your most critical questions in advance. And insist on being an active, informed partner in developing and carrying out a plan for your treatment. If the doctor you are interviewing knows so much that he/she doesn’t need to request or consider your input, and if you have the gift of time to find an alternate, say “thank you for your time” and walk out the door. Medical arrogance CANNOT take the place of a patient’s knowledge of their own body, experience, and specific circumstances. The very least a physician can do is to listen, consider whether/how the patient’s concerns can be addressed, and make the patient feel heard and understood.

  5. I live in Mississauga/Ont. I have an excellent personal MD, whom has been in my life for +20yrs and I’ve had no such issues with. I feel we have an honest relationship, and I have no problem asking as any questions as I need.

    However, a few years ago I gave birth at a hospital – and this article describes exactly what I experienced. And in that case, even though I was in delivery for 36hrs – there is very little ability to get alternative opinions. I found most decisions were not even discussed with me/my husband, but made on our behalf by the nurses.

    In hindsight, it was obvious their decisions were influenced by staffing issues, generalized experiences and hospital “statistics”, as much as they were concerned about delivering my baby. Because it was our first experience, we had no idea what to expect, and everything seemed ok on the surface. But in hindsight, the medical care was so systematic and impersonal … we barely got through it. My baby had been stuck. After I finally delivered – I was rushed to surgery, and my baby immediately rushed to Sick Kids. All of which could have been avoided if someone had better accessed me, and recommended a c-section.

    I would never go through it again without hiring a midwife, or someone with medical experience who is in my corner. Someone who 1) offers unbiased options 2) keeps me involved, and 3) help advocate for me/baby

  6. Dr. Schwartz’ book should perhaps have been written 15-20 years ago. The Institute of Medicine in the US and numerous medical education leaders around the world have long ago recognized a problem with the way physicians were being educated. With the explosion of scientific knowledge in medicine and an educational system focused on it, a steady drift was occurring away from the humanities. The healer role of doctors was recognized to be floundering and the impact on patients and their families of this trend was not positive. Canada has been an international leader in resurrecting the teaching of the humanities in medicine. The Royal College of Physicians and Surgeons of Canada and the Canadian College of Family Physicians have been directing an educational “paradigm” shift and all Canadian doctors, from medical students to residents in specialty training, to physicians already in practice, are being equipped with the skills, knowledge and attitudes required to more humanely serve patients and their families. As a practicing anesthesiologist for over 30 years, I am encouraged by the very real change that is happening in Canadian medical education in the past 20 years. Granted, there is still a lot of work to be done, but our communal efforts should be directed forwards, not wasted looking back. If you want a thought-provoking book on medicine and end-of-life care, read Atul Gawande’s Being Mortal instead. We are all in this together.

  7. I am happy with my family doctor, who really tends to treat me like a friend. She is respectful and responsive to me. If I was without a GP which is VERY common in remote areas in BC where I live, you feel very fortunate to be seen by anyone, let alone someone who actually knows you or will sit you in an armchair. We have doctors who come in for months or a year and then move on. There is almost no continuity of care or long term relationship for most people here. WE have a system that tries to lure new recruits into rural areas and then they leave very soon after. People end up waiting in emergency for hours for care, because we have no doctors. The issue of seeing a specialist in this country is in a state of crisis. I was referred to an orthopaedic surgeon for hip replacement, and it took seventeen months just to see the surgeon! It will be another six months before one of my two bad hips can be replaced, and another three months for the next one to be done. That is a very long wait, when your quality of life is sinking fast and you are in constant pain. We have decided to use our resources to have my hips done privately at the only private clinic in Canada, near Montreal. (Why can we not access private care in our own country if we are able?) We can manage to do that, but most people cannot and they are stuck, without recourse at the mercy of a broken system. It is a MESS!!! In NS people are waiting three years sometimes for hip replacement! It takes a year to see a dermatologist, and months to see many other specialists. My father in law died of prostate cancer waiting in our system while his two brothers who were similarly afflicted went to the USA for rapid effective treatment and they lived for many years after. I’m sure that many or most MDs are as frustrated as patients, but there is no end in sight and even less hope. With an aging population, you better hope you can find the money to do things privately or out of country, if you want to survive or receive any kind of timely care. It was bad years ago, today it is much worse! With a rapidly aging population,
    the bottom is dropping out and to my knowledge, nothing is being done to fix it, sadly. It is very disheartening…..

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