Houston, We Have Patient Trust Issues

Originally posted on Medscape:  http://boards.medscape.com/forums?128@895.0CyNa6uhxBx@.2a0e7260!comment=1

Jeffrey Wonoprabowo, Medical Student, 03:20PM Oct 23, 2011



I bit my tongue as a patient ranted to me about her distrust of “western medicine.” She felt that all they do is hand out drugs and that this doctor, in whose office we sat in, was able to get her off her heart meds by using diet and lifestyle changes. Out of respect for the person I was shadowing, and the fact that I was only — you know, shadowing — I held back. (I should probably say that the doctor I was shadowing did stop the patient and say that western medicine has made incredible advances and there is nothing like western medicine in the areas of acute care.) My assignment for the afternoon was to follow someone who practiced Functional Medicine. I won’t go into the details of what Functional Medicine is. That isn’t the purpose of this post. In fact, I don’t even feel like I have a firm grasp of it. But to summarize, here is a statement by the Institute of Functional Medicine: “Functional medicine is personalized medicine that deals with primary prevention and underlying causes instead of symptoms for serious chronic disease.”

Prevention is the key. And, as evidenced by my previous post, I whole-heartedly agree with that. But the distrust made me react with a tiny bit of frustration. First I focused my frustration towards the person who had expressed her distrust — obviously the focus was all in my own head, though I cannot say with certainty that my face did not betray me. Perhaps my expression was the equivalent of an eye roll. Because here was this woman who was sitting in front of me telling me that she didn’t believe in what I was doing and that I should open myself to “furthering my education” and doing more. “The nerve!” I thought to myself. 

Now that time has separated me from that incident, I am thinking about it again. But now I am wondering about what the profession has done to allow this mistrust to happen. It is our fault? As someone who is planning to enter Primary Care, I would love for my patients to be able to manage their health with prevention. But the simple fact is that most patients won’t change their lifestyle. It is easier to pop a pill than to radically change old habits. I remember talking to one attending about the management of hypercholesterolemia. He mentioned that he often advised patients to exercise more and eat better. But more often than not, they wouldn’t do it. So instead of giving them a trial of just diet and exercise, he frequently just prescribed them a statin to go along with the advice to change their habits.

Is it possible, though, that in resorting to such a practice rather than spending time counseling our patients on healthy habits, we are to blame for some of this mistrust? During the last century when the miracle drugs starting popping onto the market, people gobbled them up. Perhaps times are changing. Maybe we have a patient population that is starting to understand the value of hard work and the importance of dietary and exercise habits. Maybe we are at a turning point. Or, maybe not. 

For an interesting look at diet and lifestyle, I’d recommend everyone watch the documentary “Forks Over Knives” which features the research of Dr. Campbell (PhD) and Dr. Esselstyn (MD). Fascinating stuff!



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