Darren is feeling a little guilty right now. As well as concerned. Here’s what happened:
Darren’s primary care physician diagnosed him with a new condition a few months ago, and prescribed a medication for it. Darren likes this medication. He feels like it is improving his overall quality of life, and gives him some peace of mind, though he admits that he can’t quite pinpoint exactly how it is helping.
Last week, Darren had an appointment with a specialist who treats another condition that he is living with. When Darren provided her with a list of medications, she noticed the one that his PCP had recently prescribed.
“Why are you taking that?” she asked.
When Darren explained his PCP’s diagnosis, she replied: “A lot of patients are being prescribed this medication when they don’t really need it. Your test results indicate you are borderline at the most. So I am going to give you some things you can do that will help the condition not to worsen. And I am taking you off the medication.”
Doctors Don’t Always Agree With Each Other. Leaving You With a Choice
Darren wasn’t happy with her decision. He felt that the medication was benefitting him enough that he wanted to stay on it. As it turned out, his refills had just come to an end. And so, he sent off an email message to his PCP requesting a new prescription, which his PCP consented to.
That’s why Darren is feeling guilty. He’s also concerned that the specialist is most likely more experienced than his PCP in treating this condition. And she had not only said that the medication was not necessary, but that using it unnecessarily could be detrimental over time.
Darren also doesn’t want to be caught in a lie. And that’s what he will have to do the next time he goes back to his specialist, and she asks him if he followed her directions. He’s already not been honest with his PCP.
What about you? Have you ever found yourself in a position where you didn’t want one doctor to know what another doctor had recommended? Maybe you have also been taking a medication that you didn’t want to give up, like Darren. And chose not to tell.
This is called withholding information. No judgments here. It’s human nature. But here are some ideas to consider the next time you find yourself in this position.
Ask for clarification. Not only the reason to follow the advice, e.g. discontinue a medication, but also the potential consequences. Keep in mind that the human brain has a way of putting its own spin on information to make it fit what you wanted to hear. So as your doctor gives you the details of why discontinuation is being recommended, listen with an open mind, even if you aren’t liking what you’re hearing. You might even want to take a few notes.
Explain why you don’t want to follow the advice. I’m not saying you have to become defensive or confrontational with your doctor. And I know doctors aren’t always so open to having their patients question their advice or directions. But say something to your doctor like, “I’m feeling really comfortable with this medication. Since I started taking it, I have felt more/less _____________________________. So I think it’s helping me.”
Get specific about what you’re asking of your doctor. Do you want your doctor to let you “slide” and continue taking a medication that may have minimal value? Do you want him/her to let you continue while you put an alternative into place, such as lifestyle changes? Getting specific is good communication. Of course, your doctor may not be open to anything short of following his/her direction immediately.
Consider the consequences of ignoring the advice. Most likely, your doctor described what could happen if you continue on the medication he/she wants to discontinue. So after you leave the office, sit down with yourself, or a friend or family member, and weigh the potential of ignoring the advice against following it. Ask yourself: “Am I willing to take the chance that I might experience the consequences of continuing to use it?”
Follow up with both doctors. In Darren’s case, he needed to let his PCP know what the specialist said, and ask for his PCP’s thoughts. His PCP may have felt that Darren would benefit from the medication, and recommended he continue. He/she may have decided the specialist’s point was well taken, and chose to discontinue. Darren also needed to be upfront with his specialist about whether he was taking her advice.
Don’t forget the trust thing. I’m not trying to make you feel guilty here. But if you are considering withholding information from another physician, think about the potential outcome of having either or both doctors discover that you withheld information from them. Are you willing to risk damage to your relationship? If your doctors don’t have all the facts, they can’t treat you effectively. Don’t forget that doctors have been known to “fire” patients who don’t follow their advice or communicate with honesty.
And consider the impact on the healthcare system. Not trying to lecture you here. But unnecessary testing and treatment costs payers – insurance companies and government programs like Medicaid and Medicare – literally millions of dollars every year. And that drives up the costs for everyone. We can all do our part to avoid waste.
You and your doctor. Your relationship is built on trust. You trusting your doctor’s guidance. And your doctor trusting you to be honest. So do your part by keeping it real!