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Personal Perspective
Avoiding the Power Struggle

By David Elfstrom

Winter 2004/2005

At times, a meeting with your doctor can feel like a battle. Perhaps you've read about a new treatment that sounds exciting. Who knows your body better than yourself? You've read the drug information book, you know what symptoms to expect. You're being an educated patient. And yet here's the doctor shooting holes in your arguments and resisting your suggestions of new treatments to look into. What's gone wrong?

First of all, avoid bringing published material and printouts to the appointment. Instead, fax the article a few days ahead of time with a short note saying that you'd like to discuss it at your next appointment. But there is something else to consider: the medium itself and how it is delivered, rather than the message. A printout from the web has less impact than a professionally printed, multi-colored pamphlet. My doctors are well aware of the misinformation and scams present on the web. In fact, they instantly turn off when I say the "Internet." So I've stopped saying "Internet" or "the web." Now I say, "This information is from a non-profit organization that specializes in ..."

Do all that you can to earn the respect of your doctor. To do this, you need to make your doctor's job easier. Hopefully you've done that already by keeping a diary, being educated, using an agenda, and being assertive. One extra skill that takes a lot of practice is clearing a mental path for your doctor to follow and allowing her to do her job.

For example, when I first started taking the antibiotic minocycline, I did not go to my doctor and say, "I'm experiencing a Jarisch-Herxheimer reaction." Leave the diagnosing to them -- it's their job. Instead, describe the symptoms. If they don't make the connection, give them a hint, but be subtle. Pretend you just thought of it. Say, "You know, I think I've heard about this type of thing before, only it was in people who had Lyme disease. They often get a fever after taking antibiotics too, don't they?" By leaving the diagnosing to your doctors but helping them along, you can safely leverage their knowledge and earn their respect at the same time.

You see, it's entirely possible that you may be wrong. I was once convinced that the annoying thirst I was experiencing was due to the methotrexate I was taking for psoriatic arthritis. After all, the drug book recommended I drink lots of fluid with this drug. But when I told my doctor about this, he said the medication I was taking could not cause me to be thirsty. The next time we met, I again told him that I was thirsty, and insisted it was the methotrexate. He sidestepped the issue and quietly snuck in some extra blood tests that I wasn't aware of. As it turned out, he uncovered a problem in my thyroid gland, something completely unexpected. I was correct to be assertive because the symptom turned out to be very important. But I was wrong to be telling him what my diagnosis should be. If I had brought up the subject differently, he would have told me what tests he was running instead of being secretive.

Always let doctors think of things for themselves. You're coming to the doctor to ask for their professional advice, not to tell them how to treat you. If you want to try IV-delivered antibiotic therapy for inflammatory arthritis, you'll have to guide your doctor so he will conclude on his own that IV antibiotic therapy will be beneficial. You can help by earning their respect and providing them with the information that they ask for. Sometimes it will take two or three more appointments. Stick with it, be assertive, be patient.

David Elfstrom, 32, is a Toronto-based web developer and photographer. He has had psoriatic arthritis for 17 years but no longer requires medication for his condition after making significant dietary and lifestyle changes over two years' time.

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