Do you miss the days when your only task was reading one of Aesop’s Fables? I do. Do you remember “The Cobbler Turned Doctor?” If not, I’ll refresh your memory. It’s about an unsuccessful cobbler who decided to move to another town where no one knew him so he could work as a doctor and sell a drug as a cure against poison. When he became sick and was offered his own drug, he admitted that it was fake, which exposed him as a swindler. He literally was about to get a taste of his own medicine.
Tony Ballantyne of Nature did his own updated version of “a taste of your own medicine” for the journal’s “Futures” section (Ballantyne 2012). His comedic take demonstrates the importance of laying out the facts to the patient so they can make an informed decision. In the article, the patient refuses to learn the facts, which upsets the doctor. The patient thinks the doctor is upset because she disagrees with him but he replies:
“No!” he snapped. “You don’t get it! You’re allowed to disagree with me, I want you to disagree with me! I’d love to engage in reasoned debate with you. But until you take the trouble to understand what you’re talking about, you’re not allowed science any more. Now, roll up your sleeve.”
This discussion brings up two points. First, Aesop’s fable reminds us to treat others how we would like to be treated. When I am treating a patient, I like to think that I am treating someone very close to me, like a family member, and that they deserve the best care. Or, pretend you’re treating the Dean’s spouse, which means no mistakes are allowed.
Second, Tony Ballantyne’s article touches on the frustration in medicine when a patient refuses to be open to ideas. How many times do you sigh when a patient shakes his or her head when you attempt to explain a treatment that you feel is beneficial? How many times do you want to bang your head against the wall because you believe the treatment plan you’re offering is as clear as day but the patient doesn’t even want to consider it? It doesn’t matter how many pamphlets, posters, research papers, and testimonials you pull out, because they are not open to changing their opinion.
How many times have you heard “I will never quit” in response to smoking, even after you’ve told the patient that was a major contributing factor to the development of their aortic aneurysm? How many times have you heard “I don’t care” in response to monitoring blood glucose levels, even after you told the patient that the reason their foot being amputated is due to their failure to control their diabetes. No matter how frustrated you are, you still have to offer these options to your patients and let them know that when they’re ready, they can come to you. They may come back in twenty years with end-stage renal disease and say, “You know what, Doc? You were right.” Or, they will stubbornly hold onto their beliefs forever. If they do finally come around and glance at the brochure you hand them but still disagree, that’s okay, too. We are treating the patients and our job is to offer our expert opinion with the best possible care we can give. A patient may not have the medical background we have, but they are still entitled to decide what to do with their body. I have seen patients put their lives wholly in the hands of their doctor with, “I trust you, doctor,” whereas others, not so much. No matter what: to each his own.