Saturday’s appointment with YAS (Yet Another Specialist) sparked a small and unexpected revolution in my head. It was a teeny, tiny spark, but I am beginning to think it was more significant than I realised. Let me explain. This particular specialist had earned my undying gratitude by coming in on a Saturday to give me an appointment two months earlier than his waiting list would otherwise allow. I was disposed to adore him before we met.
Nonetheless, when he opened the door, he greeted me with “Linda, is it? I’m Dr Thingy*.” I introduced my husband and we sat down in the waiting room to fill out the obligatory forms. I carefully filled in “Dr” where it asked for my title. I worked hard for that PhD, and I like to have it recognized, but it’s particularly useful in medical situations. Even though I don’t have a medical degree (and never pretend that I do), I like to establish that I am a trained scientist and I can handle technical terms. I like to be taken seriously. I shouldn’t need a PhD to be taken seriously, of course, but the truth is that it does tip the scales sometimes.
I’ve always called doctors by their titles. Well trained by my doctor father, and also of a respectful and somewhat conservative bent by nature (20 years on I still find it hard to call my school teachers by their first names), it comes more easily to me to call a doctor “Dr Thingy” than “Jess”, even though many doctors now introduce themselves by their first names.
But even the doctors who hide behind their titles and surnames like battle armour always, always call me by my first name. And it suddenly dawned on me that using surnames and titles reinforces a psychological distance and a power relationship that might not be in my best interests. As a patient I have always had an irritating tendency to want to understand my diagnosis and make decisions about my own treatment. It drove my dad nuts, but I stuck with it. It took me a while to get to this point, but now when I encounter a doctor who isn’t comfortable with me making the decisions, I dump them post haste. This is my body. This is my health. This is my responsibility. My doctor is a partner in my quest for better health, but she can never, ever be in control.
Astute regular readers may have detected a touch of the control freak in my approach to the world, but I think this attitude transcends a mere personal tendency. For too long, some health professionals have treated their patients as devices to be fixed at worst, as naive children too young and ignorant to know what’s best for them at best. Either way, patients taking charge of their own health are not a welcome development in such cases. Here the battle armour is crucial to reinforce their supremacy and control. “I’m Dr Thingy. You’re just Linda. I’m the expert. You do what I tell you.”
To be sure, sometimes there’s a fine line between making your own decisions and ignoring expert advice in favour of quackery. I’m well aware that many anti-vaxxers believe they are making informed decisions. But it is rare that any condition has only one possible treatment, and extremely rare that treatments are without complex consequences. There are always choices to be made. There is quite a lot of medical literature documenting the fact that patients who inform themselves and take equal roles in their own treatment have by far the best outcomes.
Recently while in hospital I was told I needed a test I had already had – even though I had mentioned the results of this test to 3 separate doctors during this visit. I told them again, and repeated the date of the test, and they agreed it was unnecessary. This test was going to cost me around $400, but it was harmless (if rather unpleasant). No harm would have been done if I had allowed it to proceed, except to my bank account. A few weeks later I got a letter telling me when my appointment for the test had been scheduled! Now imagine it was a drug I was on that had not made it onto my file. Or a life threatening condition. These mistakes happen. Imagine, then, if I was put onto a drug that would interact with something I was already taking, and I didn’t question it, because my godlike Dr Thingy is the expert. He knows what he’s doing. He’d be offended if I questioned him!
It happens. It nearly killed a friend of mine a few years ago, in fact. After that he got kind of stroppy and started to push his doctors to explain and justify themselves, and his healthcare improved immeasurably.
I can’t help feeling that the best and most productive doctor-patient relationship is one of mutual respect. So if my doctor calls me Dr McIver, I will happily call him Dr Thingy. But if he’s going to go with first names from the start, then I think it might be important to put myself on an equal footing, both in his head and in mine, and just call him Fred. After all, we’re in this together.
*Not Whatsit’s real name. I should also add that the real Dr Thingy’s attitude has been fabulous, and he has not exhibited any of the issues discussed in this article. :)