Does your doctor have bad habits?

Of course she does

He may be a nose picker or nail biter, or she may be a smoker or over-eater, but that's not exactly what I mean

Do you think your doctor is able to change practice habits just because evidence shows that those habits are bad for the patient or society?

That is the topic of a recent opinion piece in the New York Times by Dr. Danielle Offri, who is on the faculty at New York University School of Medicine. She wrote an essay about how we as physicians expect our patients and their families to change their bad habits, and act in ways that we know will enhance their health, but the evidence shows that we are no better at changing our habits when it comes to how we approach certain illnesses, diseases or patients.

I have written before about certain things that physicians have been asked NOT to do to or with their patients by the Choosing Wisely campaign. And we have discussed how difficult it is for health care providers to follow Evidence-based guidelines, even when they verbally support those guidelines.

Why am I telling you this? How can you help?

One of the things I am always encouraging my medical students and residents to do is to ask questions of thier supervisors, the most important question being "why?"

Why are we doing this?

Why are we doing this in this particular way?

 

And I tell them that it is not adequate to receive an answer of "because this is the way I have always done it."

So, you can help too, by asking the question "why" when your physician or your child's physician or nurse practitioner offers advice, orders a test, recommends a course of treatment.

Don't be afraid to ask.

People tell me they are sometimes afraid to ask their physician for an explanation. And, indeed, some docs will become defensive, or think the patient does not trust them. That's OK, that means you need a different doctor. You deserve to know the evidence, if it exists. You deserve to know the risks and benefits of "routine" care. You deserve to know how your physician thinks, and what the choices really are. What I am recommending is an honest and transparent conversation. The provider might say to you: "there is no evidence for what I am going to suggest, but in my opinion this is what would be of benefit to you for these reasons" At least you will know that the physician has moved from the science to the art of medicine.

The other way you can help is by being willing to listen to the evidence, even if it goes against everything every doctor has always said and done. One of the biggest examples is the prescribing of antibiotics for every febrile illness, or every fever associated with a "red eardrum". We now know that very few of the infections children get are caused by bacteria that are susceptible to antibiotics, and we know that treating those viral infections with antibiotics encourages the development of antibiotic-resistant strains that can eventually lead to infections that are difficult to treat. So, we have guidelines that encourage watchful waiting in children with middle ear infections under most circumstances. But many physicians still treat every ear infection with an antibiotic. Why? Because they are afraid to disappoint the parents. Many will go elsewhere if they do not get the exact treatment they are expecting.

So, if your doctor does not respond to an illness in the way you expect, ask her "why?" and be willing to listen to the evidence. Do let your physician know if your child does not improve after a visit for an acute illness. Do not just run to an urgent care site or a drug-store clinic, where you are much more likely to be given medication. Continuity is important. Your child's doctor needs to see the progression of an illness, and is interested in how his or her advice worked or didn't.

After all, in order to break old habits, we docs have to form new ones.

We have to be convinced that the "guidelines" will work in our own patients. We have to have the courage to break from the traditional treatments offered by our predecessors for generations. We have to ask the question "Why?"


photo credit for child picking nose via flicker and creative commons

"Why" Wordle created by author