Chapter 5: The Arrogant Physician
Chapter 5: The Arrogant Physician I had another patient walk into my office: A very nice 75-year-old lady. She was religious, very spiritual, and had no trust in modern medicine. She saw me for rapid atrial fibrillation—her heart was beating at 200 beats per minute. The emergency room doctor called me in the middle of the night because this patient may have had a small heart attack. The emergency room doctor wanted me to be there to help him out because they had given her three different drugs and now had to give her a shot, get her out of the ER, and take care of her after two or three visits. We needed to get her heart back to a healthy sinus rhythm and regular heartbeat. We gave her a stress test to make sure there were no problems in her heart, and because there was a risk of stroke, I started her on some aspirin and some metropothal[PME10] , and she was feeling fine by that point. The office gave her an appointment for a 6-month follow-up. She showed up again, much earlier than anticipated, and, in a polite way, told me she has stopped following the treatment we planned for her because of her spiritual beliefs. The issue that I have with this kind of care is that these types of people are trying to get the best of both worlds, which is okay, but sometimes it feels unfair to me. When I am trying to get them on medicines that will help prevent these short circuits or help prevent a stroke, they don’t want it—they would rather stick with their yogis and their natural remedies and essential oils. But when they get really sick and feel like they are going to die, they call 911 and want modern medical doctors. Then we are called in to provide emergency care, leaving our families to help out and take care of non-compliant patients. How fair is that? I come from a country where care is paid for out-of-pocket, and there are systems set up where people don’t go and see their regular doctor, but this is how America is different. We like to take care of people before it becomes an emergency. Then we get touted to be an arrogant physician because we tell patients this and that, but if a patient is going to be non-compliant with physician orders, then I think there needs to be a page or paper which says that patient waives his or her right to be admitted and use the 911 system, to free up space for the compliant patients. I know it is pretty far-fetched thought, but I am trying to make the point that if you don’t have trust in modern medicine, then you need to go all the way, which means if you don’t trust medicine, you don’t trust doctors, and you want natural medicine than if you feel like you are back in atrial fibrillation, you should call your yogi, call the essential oil lady that is selling these things, pray and go to temple or church or mosque whatever you believe in. [PME11] On the other hand, you can’t really play clever and ask us to take care of you when you are really sick when you refused to listen to us before you got so sick. I know it is not going to happen, but at least think about it when you are questing your doctor’s motives or skipping your medicine.[PME12] Hopefully, even if one person who is reading can change their behavior[PME13] , we will be able to reduce the cost of healthcare, re-admission, and insurance copays. It will create a better patient-doctor relationship in which we won’t be called arrogant because the perceived arrogance comes from us trying to help our patients heal and patients being non-compliant. “The yo-yo of heart failure means you are up and down on the weight. Some months, your fluid levels are up, and it is important that doctors catch it before you have to go to the hospital.” Part of the reason our healthcare costs are getting so expensive is because congestive heart failure is one of the most expensive reasons why people come to the hospital. There is a high rate of re-admittance. It is a simple thing. I tell my patients that they should be taking their medication and follow a specific well-planned-out heart healthy diet. They should seek their doctor’s help if they notice they are gaining too much water weight in a day or if they feel chest pains or a shortness of breath. Despite my strict coaching, I still see at least one heart failure re-admittance a week. They were complacent about making an appointment because they think they will get better, so they let it go too long, and then we have to re-admit them. If the issue had been caught on an outpatient basis, we could save so many healthcare dollars. There is a patient responsibility that should be considered when analyzing the state of medicine and the perception of doctors.