Just Listen

I just got back from a brief trip to Florida. I went down there to celebrate my mother’s 85th birthday. As you might expect, her social circle has shrunk in recent years, but she did get a number of cards and calls from friends and family members. The cards were on display in her kitchen, and a few calls came in while I was there. One in particular pointed out some of the many things wrong with medicine these days.

The caller was a cousin of mine whose elderly father is one of the few remaining friends my mother sees on a regular basis. He and my father grew up together, and our families were always close. Since my father died, and his wife passed, he and my mother go out to dinner on a weekly basis. My mother had told me that he was having “back trouble,” so when his daughter called my mother with birthday greetings, she and I spoke and I asked after her father. She sounded a bit frustrated with him, and said that she had told him to “just get an MRI already” to see what was wrong, since it was clear, she said, that “nobody was going to operate on someone his age.” I did not challenge her suggestion, but I couldn’t for the life of me figure out what an MRI would add to his management, especially since, as she pointed out, he was not a surgical candidate (and his symptoms, by her account, were neither disabling nor accompanied by neurological signs). I just chalked it up to another example of consumer-driven demand, the “perfect” companion to fee for service imaging in a well-insured population, and pretty typical of what we know to be one of the causes of overutilization of imaging studies. Sad, but hardly reportable.

The really sad part came when I called her father, since I wanted to see how he was coping with his “back pain.” He told me that he was actually feeling much better, and told me that his back had not ever been the problem, but rather nagging aches in his calves. His physician had prescribed hydrocodone – really, for an 88 year old? – which lessened the pain, but made him feel woozy (big surprise there). What really made the difference, he said, was something that seemed crazy, and he wanted my opinion. Turns out he “loves” grapefruit, and eats them daily, but he read someplace that it might be interacting with his lovastatin, so he cut out the grapefruit and his leg pain got better. I totally endorsed his theory and told him that he would probably be better off stopping the lovastatin and continuing his grapefruit, but he thought I was kidding (I was not!).

So here’s the sad part. An 88 man who “loves” grapefruit is now deprived of it, so that he can continue taking a medication of dubious value in his age/risk profile, prescribed by a physician who prescribed a narcotic to someone with an adverse drug reaction. At least he stopped the narcotic before he had a complication from that! What happened to talking to patients? The patient was offering the diagnosis, and his doctor still missed it.

What is wrong with this picture?

7 thoughts on “Just Listen

  1. The question you pose can almost be rhetorical. This would be an excellent forward to any of the hundreds of books written on the poor state of delivery of healthcare in the US and how we got here. Also a wonderful example how American society treats it’s elderly, not necessary just in a healthcare setting.

  2. Great Comments Ira ! Why don’t we do a pilot study addressing both social and financial components?
    Ernesto Molmenti

  3. Statin got me. It ruined my Achilles tendons, one ruptured. I also was diagnosed with rhabdomyolysis, and research shows that it flare up and my kidneys go out. We’ll see on that, but I’m so tired of the fatigue and pain in my legs. I’m considered an old whiner, and told that the statin long ago left my body. I’m not arguing that. They can’t seem to understand that the damage caused by the statins didn’t go with the statin, and I’m trying to cope the best I can-I use ice packs for peripheral neuropathy instead of Gabapentin. Do I get any respect for that, of course not—

  4. So true. When are we as a community try to engage our patients in a meaningful discussion of tests/ treatments that are going to really impact the patient as a whole, and stop nearly looking at isolated systems/ organs ?

    I think it takes a doctor who is grounded in him/ herself and not be afraid to engage the patient and families in this dialogue .

  5. Good point. It is very difficult to connect with patients and really “hear” what they have to say if one is not self-aware. We all carry biases and each has a style of problem solving, both of which can easily get in the way of understanding patients’ preferences and helping them come to informed decisions.

    1. I am a clinical social worker and mental health attorney. I have been listening to patients and clients for many years. There is no substitute for a true professional relationship. People bring their most intimate concerns to us and they deserve to have our attention, respect and considered opinions. Technology that can diagnose faster does not absolve us from responsibility for talking and listening to those who seek our help.

      1. Anne, it’s not just technology, it’s tunnel vision with a closed mind. I believe that technology is a scapegoat. It just doesn’t help that the medical associations makes war on certain things-and HMOs and insurance companies plans insist on medical compliance with these goals. When I did intakes at my HMO-there wasn’t any facility that asked about cancer, until I was diagnosed with it.

        I was told that I was a liar, because I said that we didn’t have a history of BP, cholesterol, heart problems, strokes, diabetes, dementia, etc. We either died young from cancer or being in combat-or we lived well into our late 90s and usually died in an accident. I was told that I was a liar.

        Technology is a scapegoat for basic personal and medical flaws in the US. The ear is the first diagnostic tool that doctors have. An open mind is the second, otherwise, why should we even go to a doctor?

        My PCP got after me because I gained weight during radiation treatment. I was explaining the cream soups with dry milk powder, milk shakes, canned fruit in a sugar syrup, deviled eggs, eggs with cheese and dry milk, egg custards, tuna and mayo, etc. He asked me just where did I find that diet. I told him the ACS. He asked me just what was the ACS? I told him -American Cancer Society for radiation treatment. And he’s an English speaking American. Tunnel vision– That’s what poisoned me- cholesterol prevention-and I couldn’t take the nagging anymore. I was just trying to get my thyroid in range.

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