Updated: Aug 2, 2020
Many of you know that my final reminder in most of my medical communication is the statement; “Remember, you are your own best doctor”. This is a nudge to take ownership of your health goals while understanding that any professional health care meeting should be a two-way communication on issues and therapies.
This discussion calls into play one of the principle tenants of medical ethics namely that of “Autonomy”. This concept reminds us that we are in charge of deciding on interventions on our person and our children who we are responsible for in their youth. This “shared decision making” should involve an exchange between the care giver and patient on the prime issues on the medical decision and then a joint decision on how to move forward. This balance of power in decision making is at a distinct imbalance though in our common clinic environment. Think of the intimidating scene where patients are sitting on a table, partially covered by a gown, surrounded by “white coats” holding laptops, in the glare of bright florescent lights. This asymmetric scenario is only too common in today’s health care.
As I continue my patient care work in the Telehealth format with CareOncolgy as their US medical director offering the metabolic protocol for adjunctive oncology care, I continue hearing from patients this fear of them advocating for their care path. Many patients voice that their doctor will “drop them” if they question the “Standard of Care” (SOC) option only. Patients frequently have to shop around till they find an oncologist who will modify a protocol, consider alternative options, or actually read data on options, or work together to find the custom treatment that serves the patients unique situation. Increasingly today (as I noticed in the last half of my hospital based career), physicians rightly or wrongly feel “big brother” is watching them and if they diverge from SOC or “guideline” driven care (even with good reason and at patient insistence), they are putting themselves a risk for lawsuits or future ridicule and loss of hospital credentials.
This erosion of shared decision making is quickly eroding at both ends of our life span. Oregon was the first to legalize euthanasia for those rare unique scenarios where there was chronic suffering with no hope of recovery. The “service” is now available in 6 states and has morphed to “drive through” efficiency. The two independent physician review process with lengthily built in shared decision making is now quick, like falling through a “trap door”. Each state has a handful of well-known end of life specialists who work together and “rubber stamp” the cases without the vetting we would want a potentially temporary (or is it temporarily) depressed person really deserves. (JAMA. 2016;316(15):1599. doi:10.1001/jama.2016.14074)
On the other side of our life cycle, unfortunately things are getting complicated fast. I am 60 and had about 16 mandatory vaccinations by the age of 18. Today our lovely “little people” get up to ( because it depends on the state) 76 vaccinations by age 18. Keep in mind low risk newborns with undeveloped immune systems are getting things like Hep B and such which they have virtually no risk of exposure at that age. There is debate related to the impact of this frenzied early vaccinations on the risk of neurosensory disorders, autoimmune diseases and other escalating maladies. In most states, if a mother pointed out that a child’s older siblings had severe vaccinations reactions, post vaccination functional decline, other medical concerns, and ask for delay or partial omission of certain vaccinations they could get a medical exemption. California just eliminated this medical exemption option for thoughtful physicians who through discernment might want to delay the rapid standard vaccination protocol. These “thinking” pediatricians and family physicians are now at risk to go to jail or lose their licenses if they offer one too many exemptions which is easy to do for those doctors thinking outside the box. In addition, individuals, even if they are missing one of the 76 vaccines, can lose the right to a public education and increasingly private school education. Meanwhile vaccine companies cannot be sued by law, the incentive to improve their mandated product is minimal, and our kids are increasingly part of sick and medicated society. Stand up for sensible vaccination schedules while our little ones develop their immune systems gradually. Vaccines save lives and is an important medical advancement in society, but we have the responsibility to be thoughtful and use informed consent and common sense.
Please consider diving into the book “Curable” by Travis Christofferson who highlights some of the remarkable opportunities in our evolving understanding of science but also the tragedies stemming from our perverse incentives in our healthcare system. Travis unveiled the missed opportunity of metabolic treatment of cancer in his prior book “Tripping Over the Truth” 2017 and has done it again in his current work, Curable.
Now more than ever ...
"Be Your Own Best Doctor"
Stay Strong and Curious,