We’ve all seen the mug and likely had a little chuckle. Maybe it has even recalled to mind a particular patient or encounter. Other than thinking of it as a snarky joke (no shade on those of you who have one, truly), I have not given it much thought, until a recent patient encounter.
A few weeks ago, I had the pleasure to see a longstanding patient of mine who was unfortunately diagnosed with terminal breast cancer in her mid-30s. Not only is she well enough to come to routine appointments, but she is positively thriving. I expressed my delight at seeing her so vibrant and inquired about current regimen and any recent follow up. She was pleased to report a stable PET scan. She also noted that she is the only patient currently treated by her oncologist who did not require any dose decreases for side effects to her oral chemo drug. On further inquiry I learned that she has created a virtual database on breast cancer treatment protocols, trials, guidelines, and literature covering management of side effects from all over the world. She even taught her oncologist a few side-effect management hacks that she found in the European literature that the physician was unaware of, but grateful to be able to pass on to other patients. I congratulated her for being so proactive about her health, which prompted her to share with me that she had previously been shamed by a different oncologist for the very same thing.
Hearing this gave me yet another glimpse of understanding about the state of our current broken healthcare system. Patients feel at odds with the healthcare system for many reasons. This, the shaming of patients by their doctor for sincere efforts at self-education, is one that had not immediately occurred to me. I realized that this can have a tremendous impact not only on the doctor-patient relationship, but on the patient’s health outcomes. Quality healthcare that yields the best results must involve a partnership between a patient and her doctor. Don’t get me wrong, if a patient comes to me with bad advice from a nefarious or dubious source, I believe it is my duty to address that with her. But this can and should be done respectfully. After all, the reason Dr Google is so helpful and accommodating to patients is because our broken healthcare system is not.
For patients who are reading this, please don’t take this to mean that you must pursue an honorary degree in your diagnoses if that makes you uncomfortable. BUT, on the flip side of that, if you have a diagnosis and you choose to educate yourself to that level, I applaud you and so should your doctor, even when it means you know more than we do about it. You are the expert on your life and your body, and you have every right to participate in your health education and care. If you bring your elevated knowledge about your diagnosis and marry it with the experience of your doctor, you can achieve the best outcomes.
For my colleagues who are reading this, I see you and I understand your pain. You are doing noble work in a system that is anything but noble and puts unbearable weight on your time, energy, and humanity. Please do not take this article as admonishment. Let it be a reminder to not allow a broken system to break you personally. The system that has trained and programmed us needs us to race through thirty to forty patients a day for the sake of the bottom line, but what do we, or our patients, get out of that? We all know that this is a soul-sucking way to take care of patients, for them and for us. As I continue to grow in my practice, I realize how much I learn by engaging my patients in their care, and how much my patients have taught me both directly and indirectly. I appreciate how much more fulfilling it is to practice in a way that empowers my patients. I will not pretend that practicing on my terms is easy while the Medical-Industrial-Complex closes in from all angles, but I have firmly decided that, no matter where my practice takes me, I will not compromise my values. I am so grateful to my patients for teaching me this.
As for that self-righteous ceramic mug, there is no need to shatter it. Maybe just keep in the physician’s lounge.