Wednesday, February 27, 2013

A Talk With My Doctor

-- by Tom Phillips

My doctor was mad at me, I could tell, when I called him last summer.  He could hardly remember who I was, because I hadn’t been in to see him in two and a half years.  What have you been doing, seeing some other doctor?   No, I said, I just haven’t been sick.   That was no excuse.  You’re over seventy years old now, he said, calculating from my chart.  You should be practicing preventive medicine!    

In my opinion, I was practicing preventive medicine.   I exercise daily, eat healthy foods, don’t smoke and drink only in moderation.  Every morning I take a low-dose aspirin to guard against heart attacks.  And I stay informed about medical issues.   The more I read, the more wary I was about his version of “preventive medicine’:  that is, vaccinations against commonplace diseases like flu and shingles, and periodic tests looking for early signs of cancer.   The worst shocker was the news that the PSA test for prostate cancer, which he had administered without asking me if I wanted it, was far more likely to lead to unnecessary, harmful treatment than to save me from death by prostate cancer. 

Still, this was “my” doctor, and as far as I could tell he was competent and professional.  I didn’t want to break ties with him, because some day I will need a doctor, and I didn’t want to go through the trouble and uncertainty of searching for another.   So I decided to follow the advice of countless counselors, and “talk to my doctor.”  I worried a lot about it, fearful that he would refuse to listen to a layman’s opinion on medical issues, and dismiss me as a patient for putting my wisdom above his. I made an appointment, without citing any specific reason.   Just in case, I brought along an article by a professor of medicine, one of a number of doctors who are now warning against excessive testing and screening. 

As soon as my doctor entered the examining room, he started checking my body and its vital signs, until I interrupted and asked, “Can we talk?”  To my surprise, he seemed amenable.  He put down his stethoscope and listened to my spiel, the burden of which was that I was more worried about the risks of “preventive medicine” than I was attracted to its benefits.  He made no objection to any of my arguments, saying he could only suggest courses of action, and it was up to me to decide.  He did say he’d like to see me more than once every few years, to keep a record of my bodily functions as a baseline.   

He agreed to drop the PSA test, but recommended a colonoscopy, as I hadn’t had one for several years.   I said I was agonizing over it, after reading about studies that cast doubt on the effectiveness of this nasty, risky procedure, especially among the elderly.  He didn’t press it.  He offered shots for flu and shingles, which I declined.  No argument.  He then proceeded to take my blood pressure, perform an EKG and take blood to be tested for cholesterol, etc.  After this he shook my hand, and for the first time ever, called me by my first name.   

When I called a week later, he said I was in excellent health, and I should just “keep doing what I was doing.”  I made a mental note to see him every January, to keep in touch.   

I don’t know about your doctor, but mine turns out to be OK, just a little harried and hurried most of the time.   He worries about his mostly elderly patients, afraid they’ll hang back and avoid treatment until it’s too late.  I told him not to worry, if I think something’s really wrong, I won’t be shy about coming in.   

So we have a deal, mutual respect.  All I had to do was demand it.  Doctors can suggest, but it’s up to the patient to decide.   I’ll keep that in mind when it comes down to the end game. 

Copyright 2013 by Tom Phillips









  1. I'm with you on almost everything - but I did have the shingles vaccine when I turned 60 - it was painless - and I've heard way too many frightening stories about shingles - and not just news reports - a few personal tales. I was eager to get that particular shot!

  2. It's wonderful that you are in great health, with an approachable doctor and the means to pay for any treatment or drug which you decide (in the future) might be helpful. Sadly lots of people, including kids and sick people, don't get that 'privilege.'
    People need to become informed and critical thinking patients like you. The benefits of medical messing around don't always exceed the risks, as you point out. But not so for flu shots. They usually work, saving people from a week+ of real misery or worse, and have zero risk unless you have a horrible egg allergy. I think your doc should have put up a argument with you on that one!