Want to Meet a Scientist? Look in the Mirror!

My patient Susan looked a little embarrassed as she fidgeted with the sheaf of papers in her lap. "I hope you don't mind," she said. "I've been doing some research on the Internet. " Susan had consulted me the month or two ago about chronic fatigue. I had told her there is no single solution that worked for everyone. Did I mind that she was doing research on her own? On the contrary! Together we would figure out what worked for her. Experience shows that those who take an active effort to solve their own problems more frequently succeed.

Good Collaboration -- Good Medicine

One of our goals of writing this newsletter is to demystify medicine. There exists a temptation in the commercial media to invoke authority, to worship "science", to discourage thoughtfulness while the advertisements run, to encourage us to buy instead of make. The problem is that many times we cannot buy health; we must nurture it ourselves. Medicine is not a commodity like pork bellies. Much effective medical care results from an active collaboration between the patient and the doctor.

People often consult me for chronic conditions their insurance doctor can't or won't address. Sometimes they want me to make every decision for them. When the course of treatment is straightforward, it's easy for me to tell them what to do. Other times there are several options, none clearly promising success. As I begin to discuss the various choices, some people will look at me and say, "well, you tell me, you're the doctor." To this I may gently reply, "I'm not balancing your checkbook, nor do I know how much time you'll be able to devote to self-care at home, nor do I know the challenges you face in your life. Sometimes speedy and certain treatment requires considerable cost, and many people who come here would rather adjust the diagnostic strategy and treatment to their own situation. Let's work out together a solution that's optimal for you."

Why People Give Up on Understanding Science

There are several reasons that folks feel better outsourcing their health-care decisions.

It's Traditional -- When I started out in medicine, the doctor was God. The patient listened and followed directions as best they could. If they had concerns or reservations they simply withdrew part of themselves from the interaction, and failed to achieve the best outcome.

It's Easier – Some people hope that a pill, such as an antidepressant, will substitute for what they must do to recover health and life, such as getting outside and walking, or taking that dance class, or going on that hike, or having the discipline to put aside fear and face the uncertainty of going out and making new friends and taking on new challenges. Here's a current article about this problem.

Experts Intimidate Us – Many experts communicate poorly. Sometimes it seems they constantly change their minds. This doesn't build one's confidence in understanding the issues.

You Are Qualified

I am here to tell you that you are qualified to research, to learn, and to make decisions about your healthcare. As Steve Jobs famously said, leadership decisions are made every day by people no smarter than you.

You Were Born a Scientist

You were born with a curiosity about the natural world. Your parents may not have been happy when you knocked over a glass of milk for the second time, but you were wondering if the puddle of milk on the tray would look just as it did the first time you knocked it over. When you were little, any kind of experiment fascinated you. Your curiosity led you to taste the dirt on the floor and touch or push everything in the house. Your animal nature drove you to learn how the world worked. Millions of years of evolution have perfected that survival strategy of exploration and discovery.

Those who study human emotion tell us that happiness reaches a peak just after we have solved a problem. Children are continually working at the problem of how the world operates and what their place in it is. Might it be that their intermittent but frequent successes contribute to the joy we see in children?

You Are Still a Scientist Today

The word science is Latin for knowledge and means simply the accumulated store of human knowledge. That knowledge is built on experiment and observation. Each of us can experiment in our own lives. My patient Ralph is one example. A couple of times over the past year he'd been awakened by a calf cramp. The third time he asked himself if the ice cream he had eaten before bedtime the night before have played a role. Rarely did he eat ice cream. He decided to test his theory, to see if his observation could tell him something. The technology wasn't too difficult. He waited a week, ate ice cream again before bed, and had to get up in the middle of the night with a muscle cramp.

Here are more examples from my practice.

A patient with arthritis omitted nightshades in their diet and found that their arthritis improved. They started consuming nightshades again and their joint pain returned. The next task will be to make sure that observation is correct. For example, if the only way they like potatoes is au gratin (with milk or cream), they would need to test and see if dairy was the problem instead.

A patient noticed her blood pressure was high before her morning medication dose. She changed to half a tablet morning and evening and found that her blood pressure was normal at all times of the day. (This was done under my watchful eye – some types of tablet or capsule should not be cut).

People on insulin need to be more technology-aware. Part of diabetes care includes education that enables one to check blood sugar at home, track levels and times, observe symptoms, and adjust dosing as required. Visits to the office involve as much coaching and post-grad education as they do regular doctoring.

Science: Out of the Closet

The first day of medical school one of our professors told us that half of what they were about to teach us was wrong, but they didn't know which half. Over the intervening decades it has become clear that much of what they taught did need to be changed and improved. It seems we kept on learning!

It's a rare day when I don't begin a patient visit by reviewing my previous thoughts on their condition to be sure that more recent symptoms or lab tests haven't invalidated what I had thought was true. A physician must never let the idea that he or she might be wrong about what is going on with the patient leave their mind. When we arrive at conclusions too quickly, or when we fail to review our conclusions for accuracy, we fail our patient.

We cannot learn without sometimes letting go of what we thought was true. One of the more difficult lessons for me has been to accept that I'm not always right. Our human nature resists change and resists the recognition that we are not perfect.

So when you see a scientist on the news changing the scientific story, do not give up on your own ability to understand. The main rule of the game is to have the courage to face the mystery of this world around us. We can sit down before facts and learn from them as does a little child.

Science and Health are a Social Collaboration

In a true collaboration, each person learns from the other. We are leaving behind us a time when the physician was listened to slavishly and her advice followed without question. We are learning that without collaboration between physician and patient, we cannot achieve the best results.

Delegation of understanding to experts is dangerous to you and your health. You can take the time and effort to check out the facts.

Nurture your inner scientist!