The Doctor Parent Trap

I wish someone would loan me a book about how grown kids are supposed to interact with their parents. I have books on parenting which talk about how parents are supposed to interact with their kids. But I need advice on how to handle conversations based on the parent’s assumption of how things are supposed to work in an ideal world.

I’m no kid. I’m 55. But I often feel like I’m 17 when doctors try to explain to me why it’s okay for them to assume that I don’t have such-and-such condition rather than test for the condition. If I had something, they assume some other doctor would have already diagnosed it.

“I’d like to have a Prometheus test to determine if I have ulcerative colitis or Crohn’s disease,” I say.

“Oh, the colorectal surgeons would have already diagnosed you during surgery if you did,” the doctor says.

“When I was at my surgery follow up visit, I asked one of my colorectal surgeons if she could determine during surgery if I had an inflammatory bowel disease. She said that was not her specialty, and she referred me to another gastroenterologist.”

I continued. “I don’t know if she said this because there’s some actual or unwritten law that forbids doctors from crossing certain territorial lines…I just know doctors have been reticent to address any topic remotely outside of their specialty’s seemingly very narrow parameters.”

“Look,” the doctor said, “surgeons don’t work like horses with blinders on strictly honing in on the narrow aspect of the organ they’re operating on. They get their hands in there and feel around for any abnormalities. If they find something in an organ they don’t think looks right that’s outside of their expertise, they ask the appropriate specialist to take a look before they close up. It’s not unusual at all for different specialists to treat a patient simultaneously if another condition is discovered during surgery.”

This I knew was true based on my mom’s experience. During a routine hysterectomy, surgeons found a tumor on her kidney that turned out to be renal cell carcinoma. She was being treated by gynecologists, nephrologists, cardiologists and oncologists. She died shortly thereafter.

What I didn’t know was how the “feeling around” scenario applied to laparoscopic surgery — not hand assisted laparoscopic surgery, but three-tiny-incisions, hands-free laparoscopic surgery.

“Are you a surgeon?” I asked the gastroenterologist.

“No, but in medical school, we assisted in surgeries and saw how things worked,” he responded.

The question “What year was that?” sprang into mind but I didn’t say it. I didn’t say anything. I felt it would be disrespectful to bring up laparoscopy. I wanted the Prometheus test, a fairly new test used to diagnose Crohn’s disease and ulcerative colitis, but I didn’t want to broach any subject that might lead to the doctor’s losing face. I suspected this gastroenterologist hadn’t ever heard of the test.

Plus there was the added concern that this was someone my internist had referred — a friend he’d known for years — and I have high regard for my current internist. It took me years to find him, so I wasn’t about to do anything stupid to skew that relationship.

Since home schooling about all things medical, I’ve been profoundly fascinated at the medical advancements I discovered — surgical advancements and the slew of new tests that doctors in day-to-day practice rarely order.

I found that doctors typically don’t mention to their patients any tests that insurances typically don’t cover. I can only assume they must have surmised that if the insurance doesn’t pay for something, there’s no reason to learn about it. Some doctors even admit that they don’t test for things that they believe they can’t treat or do anything about.

What audacity I think when I hear such statements. What about testing just to inform the patient of a condition that the patient can improve by implementing lifestyle changes or by taking non-prescription supplements? Do these doctors assume that all patients are set in their ways, so why bother? Is the office visit about what that particular doctor knows or what he can help the patient with? Is the doctor’s ego worth more than the patient’s life or quality of life? And who has the right to make that judgment?

I know there’s no cure for inflammatory diseases as well as many other conditions. In fact, much of the prescription medication available only addresses some symptoms while creating other health problems. Still, it would be nice to have a proper diagnosis — one way or the other — for the patient’s peace of mind, if nothing else.

But rather than get into an argument or further discussion with the time-constrained doctor, I sat there feigning acquiescence like a child. I felt the way I’d felt previously in parent-child situations — like it was futile to try to persuade the unconvincable. It makes me think I’d be a terrible debate team member.

So why did I submit to “child” mode so readily?

It’s no secret that many doctors view their patients as children. As a real estate broker, I sometimes felt similarly about the tenants I placed because they needed my help. I felt like a mom to my pets. Yet I doubt this viewpoint lends itself to a healthy relationship — one open to honest discourse and mutual trust. Better to face each other as compassionate adults with open minds. I just don’t know how to get there.