Talking to a Brick Wall

Why do I sometimes feel like I’m talking to a brick wall when I see my doctor?

As a retired RN and a multi-cancer survivor, I subscribe to Medscape mainly to stay up on new advances in thyroid and other cancers which could affect me. Articles often offer other insights aimed at medical professionals — and recently included articles on “confidence”, “is it OK to admit what you don’t know” plus a sidebar linking an article on “arrogance”. All three articles were heavy on blaming patients for misconstruing their physician’s demeanor and provided a multitude of defensive excuses for physicians responding to patients the way they do including: unreasonable demands on their time, demands which contradict  what the insurance provider allows, the influence of bad information from “Dr. Google”, the lack of patient understanding of their condition, and more.

What becomes really telling is reading the comment section.  Some doctors could not understand the difference between “assertive”, “confident” and “arrogant” while nurses could clearly see the difference. Some doctors defended “paternalistic” attitudes while a very few stressed the need for humility and knowing one’s own strengths and weaknesses.

We all want a doctor who is confident, who listens, gives us the time it takes for us to understand their guidance and doesn’t dismiss our concerns out of hand. Recent responses from thyroid cancer survivors to an informal survey [see note] indicated only 51% felt their doctor was helpful in resolving thyroid related symptoms. At the same time over 80% indicated they have symptoms of over or under medication at least some of the time. Education was woefully absent – less that 20% received information on tests, side effects of medication, what to do in an emergency if you can’t get your thyroid medication (hurricanes, winter storms, fires). Only 32% recalled receiving education about follow up scans and cancer markers. This reflects many of the questions and replies we see on thyroid cancer forums – if it weren’t so, there really wouldn’t be a need for these online support groups.

Open ended responses were both discouraging and positive, the good news being many indicated they had excellent rapport with their care providers – someone who seems to understand and care for them as a whole person.

I’ve had experiences at both ends. A first surgeon was in a rush, came across as arrogant and seemingly uninterested in either my history or concerns. The surgeon I subsequently chose was confident, able to precisely explain things, took the time to address concerns and elicited questions I didn’t realize I had. I believe patient confidence in their provider contributes to a better outcome.
I also encountered endocrinologists who fell into either the “arrogant” or “paternalistic” mode before I turned my cancer care over to a fellowship trained endocrine surgeon who is brilliant yet willing to admit what she doesn’t know and is open to new research and information whether presented at a physician seminar or by a patient.

There is a lot of “woo” on the internet about “everything thyroid” which negatively influences attitudes concerning anything not supported by double blind university level studies. Yet much of the current “official boilerplate” guidance in endocrinology appears to have been supported by industry, is based on low quality of evidence or does not apply to post thyroidectomy cancer patients. When endocrinologists fail to work with their non-responding symptomatic thyroid cancer patients, these patients continue to be symptomatic, are prescribed  drugs to counter the side effects of under or over medication or are driven to seek other providers — non-endocrinologists — who may or may not provide appropriate care. The fortunate patients are the ones who engage with an endocrinologist who is not afraid to both teach and learn, to think outside the box and to view the patient as an person, not just a set of isolated lab results.

As one physician commented on Medscape… ”Arrogance is a doctors enemy. Be humble. Patients will understand. Make another visit if time runs out. And don’t withhold info or give parts of it to shut the patient up. They are are not stupid and they will find out and that’s where the problem begins. Be honest and respect your patients intelligence and they will care and respect yours too!”

[Note] Over 300 thyroid cancer survivors responded to an informal survey which mirrored the results of the Risk Factors for Decreased Quality of Life in Thyroid Cancer Survivors: Initial Findings from the North American Thyroid Cancer Survivorship Study.