Why doctors make bad patients

I’m a doctor. And, like most medical professionals, I’m a bad patient.

Two years after my last appointment, I got a CTJ, “Come to Jesus” from my doctor.

I called his office for a form. I needed proof that I don’t have tertiary syphilis. For my Thai visa.

Why tertiary syphilis, as opposed to HIV, cholera, lepers or bubonic plague? I don’t know. That’s the power of bureaucracies. They don’t have to make sense. They make the rules.

My doctor wasn’t happy. “Come get seen or get lost,” he said. Or something to that effect. Politely wrapped.

I went.

Good news: I didn’t have tertiary syphilis.

Bad news: I didn’t have a colonoscopy either. At 57, I’m seven years late. No recent mammogram either. As for the PAP smear …

Whatever you think, I’m not totally negligent. I brush my teeth. I floss. I pay attention to what I eat. Too much, maybe. I work out. I don’t smoke. Anything.

But I live and work in a small community in the North Country.  I know every doctor, including the vets. I work daily with the OB/GYNs and the GIs. Nice people. Down to earth, outdoorsy, mostly easy-going. I love seeing them in the ER, though they seldom feel the same way. We commiserate about the weather. We bash the administrators’ latest move. We’re friends on Facebook. I know the names of their dogs, the size of their wives, and how many cocktails they had before posting.

I like them, but a colonoscopy? That’s a level of carnal knowledge I’m not up for.

I don’t know about you, but I find it easier to show my privates to people I don’t know than to my friends. Having them examine my insides – and my outsides – is not my idea of fun. Not like it’s life and death, people! Yes, I see them in the ER. I examine them. I even intubated a few. But they didn’t have a choice! They were dying!

My doctor got it. He didn’t care.

“You need preventive care. You’re way past due for colon cancer screening. And pap smear.”

“But I’ve never had a bad pap smear! And my social life is not worth mentioning!”

He nodded, smiled, and referred me across the lake, in the next state, for GYN. He got me Cologard.

What’s Cologard? It’s a test for colon cancer that doesn’t require a colonoscopy. You provide a sample (of you know what) in the comfort of your own home, then send it for DNA testing.

I can do that, I thought.

Yesterday was Christmas in July. The mailman brought me a Doximity plaque proclaiming me “The most entertaining author,” and a cardboard box of Cologard with multiple interrelated plastic parts and 80 pages of bilingual instructions.

Did you ever buy furniture from Ikea? It’s DIY. Comes in boxes. The instructions are more entertaining than straightforward. My success rate is 1:3. Three assemblies to get one right. Cologuard must use the same writers.

Instructions started with Step 6: Label your samples.

That’s jumping the gun a little, I thought. But I didn’t let that deter me.

Next brochure: How to return your kit. Four pages later, I got enlightened: Weekend pooping is a no-no. The package needs to be sent immediately and tested within 48  hours.

Further explorations brought me to another unputdownable 60-page brochure. Indications, contraindications, warning, precautions, test interpretation, risks, and more. The style was crisp, the images graphic, the protagonist daring.

Twelve pages into it, I got to Step 1: Check the expiration date, then to Step 2: Prepare to collect a stool sample. How to assemble your Cologard kit and avoid pooping next to it. Or something to that effect.

I pulled the heavy zipper bag out of the box to remove the contents. It wouldn’t come. I pulled harder. Nope. I turned it upside down and shook it. It was stuck.

I tore it off the box. Then I saw it, right there.  Leave the plastic bag and the white tray inside the box.

I pushed it back to cover the tear, and I engrossed myself in lecture. Half an hour later, I’m an expert in Cologuard. I can’t wait to test my new expertise, once the weekend is over.

The pap-smear, you say? Seriously? I hope he forgets about it!

But that got me thinking. Am I foolish to avoid preventive care? I wouldn’t let my patients do that. Am I risking my health? My life maybe? Why?

Is it because I’m a doctor? Do I secretly believe that my medical knowledge will keep me safe? That I’ll know it if my body goes rogue?

Or is it just the opposite? Do I know enough about medicine, including how little we really know, to lose respect for the science?

There’s so much we don’t know. Then, half of what we do know is wrong. We just don’t know which half.  From blood-letting to smoking and coffee, the only constant in medicine is change. This here is just the latest.

Or is it the NNS, the number needed to screen, that makes me hopeless and fatalistic? 25,000 to prevent one death from melanoma. 1374 (every five years) for colon cancer, 2451 for mammograms. They cost money and time. They have risks. Many risks. False positives, exposing you to more studies. Colon perforation. Infection. Bleeding. Sedation gone bad. More.

Is that why I’m a bad patient? Maybe. But I’m not an exception. Most medical professionals are bad patients.

We should take better care of ourselves. We should sleep more. Drink less. Avoid stress. Get our colonoscopies and our mammograms. Ask for help when we need it. We’d live better and longer.

But we don’t. Why?

I hope I remember that next time my patients are difficult and noncompliant.

In the meantime, I’ll go look for some essential oils. Anybody knows how to grow aloe?

Rada Jones is an emergency physician and can be reached at her self-titled site, RadaJonesMD, and on Twitter @jonesrada. She is the author of Overdose.

Image credit: Shutterstock.com

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